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Background: Individuals with mental disorders have a significant risk of experiencing a deterioration in their oral health due to several factors. This crosssectional descriptive study aimed to evaluate the influence of socioeconomic and behavioral factors on the caries experience of adults with mental disorders in a large Brazilian metropolis. Methods: A total of 753 adults diagnosed with schizophrenia or depression participated in the study. They were users of 10 public mental health outpatient clinics located in the city of São Paulo, Brazil. These adults provided data on socioeconomic characteristics, medication use, and behaviours related to general and oral health. Oral heath examinations were conducted to evaluate dental plaque and caries experience. Results: It was observed that the chance of presenting decayed, missing due to caries, and filled teeth (DMFT) above the sample median was significantly higher among older individuals (OR = 11.62; 95% CI: 8.11–16.66), those with lower education levels (OR = 1.76; 95% CI: 1.23–2.53), those who used tobacco 3 or more times per week (OR = 1.74; 95% CI: 1.18–2.56) and those with a higher biofilm index (OR = 1.45; 95% CI: 1.01–2.09), p < 0.05. The DMFT index (mean ± SD) was 15.3 ± 8.4 for individuals with schizophrenia and 15.8 ± 8.3 for individuals with depression. Mean plaque index was 2.81 for participants with schizophrenia and 2 for participants with depression. Conclusion: The sample of Brazilian adults with mental disorders had poor oral health, which was associated with socioeconomic, behavioural, and oral factors.

Background: Oncostatin M (OSM), a 28 kDa glycoprotein 130 pleiotropic cytokine belonging to the interleukin-6 (IL-6) family, is mainly produced by neutrophils, activated T cells, monocytes, and macrophages. In response to tissue injury, it may stimulate the production of IL-6 alone or act synergistically with IL-6 or TNF-a contributing to the inflammatory cycle. Periodontitis is an inflammatory disease resulting from a dysbiotic bacterial community, which has a strong association with increased OSM production. Objectives: To investigate and compare the levels of salivary and serum OSM in healthy subjects and subjects with periodontitis. Materials and methods: Eighty-eight (88) individuals between the ages of 25 and 60 years were divided into 2 groups of 44: a periodontally healthy group (Group A) and a periodontitis group (Group B) based on clinical examination and radiographic analysis. Evaluation of salivary and serum OSM by enzyme-linked immunosorbent assay (ELISA) was performed in both groups. Results: There was a significant difference in OSM levels between Groups A and B (p < 0.01), with higher values in Group B. There was a positive correlation between the clinical parameters and OSM levels, indicating that OSM plays a significant role in modulating the inflammatory response of periodontal tissues. Conclusion: The expression of cytokine OSM may play a potential role in the immunopathogenesis of periodontitis, suggesting a role as an inflammatory diagnostic marker.

Introduction: Community-based rehabilitation (CBR) centres in Malaysia were established to enhance the quality of life of persons with disabilities (PWDs), including their health care. It is unknown to what extent PWDs have been taught about oral health care at CBR centres. Objective: This qualitative study investigated the perceptions of CBR managers regarding the level of training in oral health care received by CBR workers, the current oral health care program for PWDs, and the barriers and enablers in providing oral health education, care, and services for PWDs in CBR centres. Methods: A semi-structured interview questionnaire and face-to-face in-depth interviews were conducted with CBR managers (n = 9) from 9 districts in Kuala Lumpur and Selangor, Malaysia, to seek their views on the focus topics. Audiorecorded interviews were transcribed verbatim, and transcripts were analysed in MAXQDA software. Qualitative data were analysed via thematic analysis. Results: Interview content analysis revealed 4 themes, 11 subthemes, and 13 codes. The 4 identified themes were oral health care education and training for CBR workers, oral health care programs and protocol for CBR trainees (PWDs), barriers and enablers to care. Conclusion: In all CBR centres, CBR workers and PWDs receive an oral health presentation, training in oral health care, and are provided with treatment by a dentist assigned by the Ministry of Health. No specific programs, training or special courses were provided by the Department of Social Welfare. Several personal, professional, and social factors were identified as affecting the provision of oral health care to the PWDs.

Background: Combining visual thinking and storytelling makes whiteboard animation an effective educational tool. However, the impact of whiteboard animation is understudied in health science education. This literature review explored the use and impact of whiteboard animation on teaching in health science education. Method: A comprehensive electronic literature search was conducted in 5 databases: PubMed, Google Scholar, CINAHL, Web of Science, and Education Research Complete to identify fulltext research articles published in English between 2013 and 2024. Articles were screened to match inclusion criteria, and data were extracted from the eligible studies. Results: After 2 rounds of screening, 6 articles were included in the review, all focussing on evaluating the impact of whiteboard animations in dental, medical, and other health science education. All studies reported positive impacts on student satisfaction and knowledge acquisition. A correlation between the number of video views and students’ longitudinal exam performance was also reported. Discussion and Conclusion: The concise and engaging animations explaining concepts in a storytelling manner offer an alternative mode of presenting teaching material, reducing extrinsic cognitive loads on the learners. Further studies are needed to evaluate the impact of this powerful tool on health science education.

Background: The influence of prebiotics and probiotics on oral microbiome composition, addressing dysbiosis, and aiding in the regulation of the immune– inflammatory response has recently been discussed. The objective of this scoping review is to explore current literature that examines the use of prebiotics and probiotics as adjunctive therapy for the treatment of periodontal disease with the intent to identify gaps in the literature to inform future research and dental hygiene practice. Methods: This review was conducted from December 2022 to August 2023 using the Arksey and O’Malley approach and PRISMA-ScR guidelines. Three databases were searched using combinations of keywords. Only peer-reviewed human/in vitro studies published in the last 10 years were included. Results: The search retrieved 204 articles. Duplicates were removed, titles and abstracts screened, and the full text of 80 articles examined, resulting in the inclusion of 19 articles. Discussion and Conclusion: Most of the included literature indicated that probiotics have a positive impact on periodontal health as evidenced by changes in periodontal disease parameters. Future research should further examine various modes of administration and dosages. The effects of specific prebiotic and probiotic strains on specific pathogenic bacteria in conjunction with non-surgical periodontal therapy should also be further explored.

Background: Recently, an increasing number of immigrants and asylum seekers and refugees (ASRs) have settled in both Canada and the United States. The poor oral health status prevalent among this population is a significant issue. Oral health professionals in both countries should understand newcomers’ experiences with oral health care services to become more culturally competent. This narrative review aims to explore the experiences of immigrants and ASRs with oral health care in Canada and the United States and identify research gaps for future qualitative studies. Methods: This review was conducted from January to April 2024 using Arksey and O’Malley’s framework and the PRISMA-ScR guideline. Four electronic databases (PubMed, CINAHL, DOSS, and EMBASE) were searched using keywords grouped under 2 themes: “immigrants” and “oral health service.” Only peer-reviewed qualitative articles published in English within the last 10 years were selected. Results: Of 1349 original studies identified, 8 articles were included and reviewed. Three main themes emerged from newcomers’ perspectives on their experience with oral health care in Canada and the United States: quality of care and professional behaviours, concerns about pediatric oral health care, and challenges in accessing care. Discussion and Conclusion: There is a need to improve cultural sensitivity and cross-cultural communication skills curricula in professional oral health education. Furthermore, making dental insurance more affordable, clarifying coverage for newcomers, and promoting collaboration between stakeholders and policymakers are essential to addressing the oral health concerns of immigrants and ASRs. Future research should prioritize primary interviews to gain more insights into newcomers’ experiences when accessing oral health care.

In 2008, Alberta registered dental hygienists received authorization to prescribe specific Schedule 1 drugs for dental hygiene care upon completion of an education course approved by the regulatory body. This descriptive, cross-sectional study used an online survey delivered via REDCap to gather information on the prescribing practices of eligible dental hygienists, as well as the barriers they encountered when writing prescriptions. The research team developed the survey with closed and open-ended questions using existing literature and research team content expertise. Five dental hygienists with knowledge and expertise in prescribing assessed validity; the regulatory body provided feedback on the survey. The survey was launched in October 2023 and remained open for 3 weeks. Descriptive analysis was completed using JASP. Surveys were received from 85/217 eligible respondents (39% response rate). Sixty-three percent of respondents (48/76; data missing for 9 respondents) had written prescriptions. Respondents reported that prescribing was extremely/very (48%) or reasonably/somewhat (44%) valuable to their clinical practice. When needed, respondents collaborated on prescription writing with dentists, pharmacists, and other dental hygienists. Dental hygienists reported the most confidence in prescribing anti-infective agents (60%), antibiotics for prophylaxis (60%), antivirals (41%), and lesser confidence with antifungals (28%), topical corticosteroids (18%), and pilocarpine for Sjögren’s syndrome (14%). Barriers to prescribing were experienced by 44% of respondents, who highlighted resistance by the dentist to allowing dental hygienists to write prescriptions, limited functionality of office software programs that don't recognize dental hygienists as prescribers, and decreasing confidence of dental hygienists due to office restrictions or lack of need to write a prescription. Understanding dental hygienists’ frequency of use and confidence in their prescribing practice can contribute to further refinements of their role to support increased use of the restricted activity in practice. Barriers to prescribing experienced by dental hygienists illustrate a need for further development in their ability to advocate for their full practice role.

Patients and dentists have increasingly accepted dental implants to restore edentulous spaces. Daily care for dental implants is more complex and vital to promote implant longevity and health. Research is limited on dental implant status in residents of continuing care (CC) or independent living facilities. This pilot study assessed the oral health status of older adults with and without dental implants living in CC or independent facilities in Alberta. Two registered dental hygienists and a dental hygiene student collected the data using the Canadian Oral Health Screening Tool for Seniors (COHSTS) from July to November 2023. Data collected examined mobility, plaque, bleeding, and suppuration around dental implants and the status of soft tissues, prostheses, dentition, saliva, and pain. Data analysis was completed with descriptive statistics. Ninety-seven (97) participants were included in the study; 82 from CC and 15 from independent living. Six participants had dental implants, with a total of 43 dental implants. Forty-one implant sites (95.3%) had plaque, and 13 implant sites (30.2%) exhibited bleeding of surrounding gingival tissue. Eighty participants (82.5%) had some natural teeth, and 75 participants (93.8%) had the presence of plaque, calculus, and food debris around their natural teeth. Nearly all participants, with and without implants, had high plaque levels. Plaque is a modifiable factor in the disease progression of implants. Unlike natural teeth, dental implants are not a naturally occurring substance. Therefore, they are more susceptible to inflammatory conditions that may lead to dental implant loss. Oral health practitioners should prioritize educating patients on home care techniques before the placement of dental implants to reduce disease risk. Lastly, dental implants should be identified upon admission into CC to ensure care staff are flagged to the specialized care dental implants require.

The war in Ukraine has resulted in a mass exodus of Ukrainians from their country. Many have sought resettlement in Canada. There is a lack of research, particularly qualitative, on the oral health care experiences of newcomers to Canada both in their country of origin and once in Canada. The increase in Ukrainian newcomers to Canada requires an exploration of barriers to and facilitators of access to oral health care to inform policy. Utilizing a narrative qualitative methodology, in-depth, semistructured interviews were conducted, audiorecorded, and transcribed verbatim. The transcribed data were read, reread, and coded line-by-line inductively and deductively and analysed thematically. Codes were grouped by 3 reviewers to form categories and themes. Participants identified facilitators of oral health care that included friends and family, social networks, and information provided through the workplace. Barriers to access included cost, referral process, location and wait times for specialists, language, and lack of understanding of the oral health care and dental insurance systems in Canada. Ukrainian newcomers to Nova Scotia face several barriers to oral health care. Interventions to address these barriers should be considered to ensure equitable access to oral health care services during the resettlement process.

Development of a strong professional identity early in the training and education of dental hygiene students can contribute to the development of their interprofessional identity in the workplace. Other health professions report extensively on professional identity. However, little is known about professional identity development among dental hygiene students. This scoping review sought to determine what is currently known about professional identity and the link between professional and interprofessional identity specifically among dental hygiene students. Using Arksey and O’Malley’s scoping review framework and Levac’s modified framework, the following 8 databases were searched: Medline/PubMed, CINAHL Plus, Cochrane Library, EMBASE, Scopus, ProQuest Dissertations & Theses, Google, and Google Scholar. A health sciences librarian guided the development and implementation of the search algorithm. Studies were limited to those involving dental hygiene students, quantitative and qualitative studies, and those available in English. From 2657 identified articles after duplicates were removed, 24 were full-text reviewed, resulting in 12 studies that met the inclusion criteria and were reviewed independently by 2 reviewers followed by data extraction. Four themes were identified: 1) confidence through learning/practice opportunities; 2) perceived value in the dental hygiene profession; 3) understanding professional roles; and 4) perceived value of dental hygienists in interdisciplinary experiences. Dental hygiene curricula should be purposeful in designing learning activities to support the development of dental hygiene professional identity and ensure that appropriate guidance is available to students during interprofessional learning experiences. Future research is needed to examine how a student’s professional identity evolves across the program, following graduation, and entering practice.

Interprofessional education for collaborative practice (IPECP) in pre-licensure education promotes professional and interprofessional socialization. Within IPECP, students develop understanding of their professional role and begin forming an interprofessional identity where collaborative attitudes, behaviours, and skills are cultivated. It is not well understood how oral health students are involved in IPECP and prepared for collaborative practice. This review assessed the literature on IPECP models used within oral health pre-licensure education, guided by the research questions: 1) What IPECP experiences enable professional/interprofessional socialization and interprofessional identity development? 2) What IPECP experiences best enable developing collaborative skills, behaviours, and readiness for collaborative practice? This review was conducted in accordance with JBI methodology for scoping reviews, PRISMA-ScR, and used an a priori protocol. CINAHL, DOSS, PubMed, and APA PsychInfo databases were searched. Peer-reviewed articles, published within the last 10 years, in English, and specific to IPECP models used in pre-licensure education of oral health students were eligible. Articles (N = 321) were screened by 2 reviewers for title/abstract, followed by full-text review using a critical appraisal tool. Twentyeight (28) articles were included in the study. IPECP models included case studies, simulation, and clinical practice/ service-learning. Hybrid experiences that provided socialization opportunities and experiential learning were most impactful for understanding professional roles and scopes. IPECP beyond a single event/timepoint enabled development of collaborative skills and behaviours. Longitudinal exposure to IPECP enhanced students’ preparedness for collaborative practice. However, siloed education of students persists, challenging interprofessional identity development. Increased integration of oral health students into health professions IPECP is needed. Revision of IPECP curricular materials to enable students to explore their professional contributions to interprofessional teams is required. IPECP for developing an interprofessional identity in oral health students remains understudied; longitudinal and qualitative analyses are needed to inform impacts and development.

There are notable gaps in health research arising from a failure to reflect population demographics and the diversity of Indigenous peoples in Canada. Notably, Métis people are a distinct Indigenous population in Canada, yet their experiences of health are under-represented across many health disciplines, including oral health. The purpose of this study was to co-create a deeper understanding of the oral health experiences and perceptions of a Métis women’s kinship group in northeastern Alberta. Approaching this study through an Indigenous research methodology, Keeoukaywin, the Métis researcher visited with 10 women in her kinship network in northeastern Alberta. Consent was obtained and individual and group visiting sessions were audiorecorded and transcribed. Collaborative story analysis through a culturally relevant framework of Métis rug braiding synthesized the co-created meaning of the knowledge holders’ experiential knowledge into a braided rug of understanding. The 4 braids represented the kinship group’s attitudes and beliefs about oral health, selfidentified barriers and facilitators to oral health, and their vision for oral health and oral health care delivery for Métis people. These knowledge holders held holistic beliefs and pragmatic and adaptive attitudes towards oral health. They identified geographic, food, water, and financial resource limitations as well as racism as barriers to oral health. Facilitators to oral health included knowledge transmission supported by Métis women’s kinship systems and ways of being. This study provided a descriptive understanding of attitudes and beliefs, barriers, and enablers Métis women in this community hold towards oral health for themselves and their families. The findings addressed individual and cultural promotive factors facilitating oral health, such as women’s cultural wellness and visioning for relational, culturally safe service provision. The study is limited to one Métis women’s kinship group and does not speak for all Métis women. However, the stories gathered resonate with emerging Métis-specific, community-led health literature.

This project, using focus groups and a national online survey, investigated the levels of interest in and barriers to pursuing further education among Canadian dental hygienists who practised with a diploma as their highest educational credential. A mixed-methods approach was employed first with focus groups to supplement answer options for the online national study that followed. The online survey was distributed to eligible CDHA members. In addition to collecting demographic information, the online survey inquired into levels of interest in and barriers to pursuing further education. Quantitative data were analysed using SPSS version 28.0 software; qualitative data, using Saldaña’s approach of assigning descriptive and in-vivo coding. Of 918 dental hygiene respondents, 553 (60%) expressed an interest in pursuing further education. Barriers to pursuing further education in thematic prevalence were time (56%), finances (53%), family commitments (51%), work responsibilities (48%), stress and/or anxiety of returning to school (40%), accessibility (34%), unfamiliarity with existing programs (34%), lack of awareness of eligibility (32%), competitive application process (27%), employer support (25%), family support (18%), completing online courses and/or using technology is intimidating (18%), and reliable internet service (13%). Levels of interest in and barriers to pursuing further education were compared with surveyed demographics to determine correlation. Findings from this study may inform CDHA, provincial associations, and educational institutions about ways to reduce the identified barriers and facilitate the furthering of degree education for Canadian dental hygienists.

Admission processes are multifaceted, evaluating candidates academically and personally through supplemental applications and multiple mini-interviews (MMI), which are crucial for assessing non-cognitive attributes essential for health care professionals. To ensure equity and fairness, understanding the influences of demographic factors on admissions is imperative. This study analysed how demographic factors impact admissions into The University of British Columbia’s Dental Hygiene Degree Program (DHDP). A retrospective cohort analysis was conducted on admission data from 3 cohorts of the DHDP: 2021, 2022, and 2023. The dataset included demographic variables such as gender, age, origin, and educational level, as well as academic metrics such as grade point average (GPA), supplemental scores, MMI scores, and acceptance status. The project received an exemption from the institution’s behavioural research ethics board. Statistical analyses were conducted using IBM® SPSS to assess the impact of these variables on admission outcomes. Changes in application rates and eligibility criteria were observed over the 3 admission years. The candidates represented a diverse demographic, with females aged 18 to 22 years comprising the majority. Notably, superior performance in GPA and supplemental scores were exhibited by secondary students, while postsecondary candidates excelled in the MMI, likely due to their greater academic and life experiences. No significant biases against gender or educational background were found, suggesting fairness in the admissions process. However, a significant association (p = 0.019) was noted in the 2021 cohort between applicants’ origin and acceptance. The higher acceptance rate for domestic candidates could be attributed to the impact of the COVID-19 pandemic on international travel. The admissions process demonstrates a commitment to equity, with no discernible biases. The observed reversal in performance between secondary and post-secondary students across application phases underscores the complexity of admission dynamics, providing valuable insights for transparency in the selection process.

Interprofessional collaboration has been recognized as valuable for enhancing the effectiveness of health care systems. It holds significant potential as an innovative strategy for addressing challenges within the health care model and workforce, ultimately contributing to the strengthening of the health system and the improvement of outcomes. The objective of this study was to evaluate the potential impact of a prenatal care protocol on interprofessional collaboration and oral health-related quality of life. The patients were predominantly young and had either incomplete or complete high school education, with no significant differences observed between the test and control groups. Pregnant women in the intervention group demonstrated a greater perception of interprofessional collaboration compared to those in the control group. Furthermore, self-rated oral health and oral health-related quality of life showed improvement post-intervention. The intervention fostered team empowerment, resulting in a reorientation of the work process with increased involvement and collaborative professional interaction, supported by the performance of dental hygienists. The service organization protocol, despite initially causing tensions, ultimately resulted in positive effects on interprofessional collaboration and oral health-related quality of life. These findings underscore the importance of dental hygienists in integrating activities between oral health and multidisciplinary teams, thereby enhancing oral health-related quality of life, and promoting interprofessional collaboration.

Interprofessional peer-to-peer (IP-P2P) pedagogy involves students from different health care disciplines with no formal teaching experience teaching peers with a similar education level. Students learn with, from, and about each other. This study assessed changes in dental hygiene students’ knowledge, skills, and perceptions of nutrition education before and after implementation of an IP-P2P educational model at The University of British Columbia (UBC). A pre/post study design examined changes in students’ knowledge, skills, and perceptions from baseline traditional lecture-style classes (2019–2020) to postimplementation of phases 1 (2020–2021) and 2 (2021–2022) of a new technology-enhanced blended IP-P2P curriculum. Phase 1 included viewing, discussing, and assessing nutrition knowledge using video-based case studies online; phase 2 added a P2P component to the video-based cases. UBC’s Behavioural Research Ethics Board (H20-00358) approved this project. A 5-point Likert scale was used in the baseline (n = 23) and phase 1 (n = 25) surveys that showed a range of responses to 15 variables, including dental hygiene students’ working knowledge of nutrition, attitudes towards peer-to-peer education, and ability to work on interdisciplinary health care teams. The statements in phase 1 with highest agreement were as follows: I had to prepare for class to be successful (p = 0.006); Teaching and learning methods promoted understanding and application of key concepts (p = 0.042); and Course work facilitated critical thinking and problem solving (p = 0.001). In phase 2, all respondents reported positively to the IPP2P component added to the curriculum. Open-ended comments from all 3 years of students recommended more opportunities for case discussions and interactions in the IP-P2P component to better understand scopes of practice. Students’ responses indicated the blended curriculum improved student outcomes while retaining interest in both online and classroom settings. The addition of the IP-P2P model encouraged interprofessional collaboration among health care students while developing their problemsolving skills.

During the COVID-19 pandemic, educators moved their lectures online, yet passive teaching methods resulted in student disengagement. In response, course materials were redesigned to support a hybrid teaching approach, with interactive modules geared towards increasing engagement and critical thinking and enhancing personalized learning. This study aimed to assess the effectiveness of newly developed interactive preclinical learning modules in enhancing student engagement and knowledge retention in the Dental Hygiene Degree Program (DHDP) at The University of British Columbia (UBC). A pre/post-study design evaluated the impact of an interactive curriculum on second-year DHDP students. Data from 2 cohorts, before (2023) and after (2024) module implementation, were compared. Interactive modules were designed using the Universal Design for Learning principles and H5P for interactive multimedia. The study examined changes in students’ knowledge retention and engagement and overall learning experiences. This project was approved by UBC’s Behavioural Research Ethics Board (H23-01154). Prevalidated surveys using UBC’s Qualtrics Survey tool assessed dental hygiene students’ online course satisfaction using a 5-point Likert scale across 32 variables. In 2023, 12.5% rated online learning as poor, with 50% of students expressing dissatisfaction with online learning compared to face-to-face. However, 50% of the 2024 cohort rated the enhanced learning modules as good, with 6.3% rating them as excellent. Interestingly, participants aged 20 years and older tended to rate the interactive modules higher (p = 0.0308), emphasizing the importance of frequent participation in online learning (p = 0.0150). Cohort differences were observed in readiness for hands-on training, with the 2024 cohort demonstrating higher levels of agreement. Additionally, both cohorts valued realistic scenarios and faculty interaction in synchronous sessions. Students prefer interactive multimedia modules for increased engagement and application of knowledge in preparation for clinical practice. Findings underscore the need to adapt teaching methods to cater to diverse learner preferences and the evolving landscape of online education.

Interprofessional education (IPE) promotes a team-based approach, lifelong collaboration in the profession, and integration of dental hygienists into primary health care teams, connecting oral health to overall health. This study aimed to identify dental hygiene students’ perceptions of collaborating with other health professionals in providing care. It involved dental hygiene students attending an interprofessional workshop where they were tasked to work on a case study in a team with students from other health professions. Data were collected from student reflections on the workshop from 2022 to 2024. Thematic analysis was used to examine the data, allowing the researchers to identify, analyse, and report patterns. Interrelated themes emerged from student reflections: • increased understanding of roles and responsibilities of different disciplines • increased awareness of the interdisciplinary approach to improving overall patient health • lack of value accorded to dental hygiene by other health professions • development of interpersonal communication skills • need for additional interprofessional experiences The findings suggest that dental hygiene students would like more opportunities to practise team roles and work directly with students in other disciplines. IPE opportunities should be introduced early in students’ education to develop a foundation for interprofessional collaboration and continued emphasis on IPE activities. Interprofessional activities are needed in curricula across the health professions to support future collaboration and quality patient care. The dental hygienist’s role in attaining overall systemic health would be valued through IPE and interprofessional collaboration.

Students frequently hear about the importance of their wellness but translating words into action for a salutogenic learning environment demands more than mere theoretical discourse. Research has identified the pivotal role of wellbeing in facilitating academic success, underscoring the significance of nurturing a balanced approach to student life, particularly within the realm of future health professionals. This pilot project sought to integrate wellness activities into the Diploma in Dental Hygiene Program at the University of Manitoba and evaluate students’ perception of the impact of these activities on their sense of well-being and school/life balance. Students, organized into groups of 5 to 7, engaged in half-day “Wellness Experiences” once per term (fall 2023 and winter 2024), choosing activities from a selection offered. In the fall term, 24 senior dental hygiene students participated in activities such as rock climbing and dog therapy, while in the winter term, 26 junior students engaged in activities such as pottery painting and board games. Faculty participation ensured the smooth execution of each experience. Postactivity surveys gauged students’ pre- and post-experience well-being and its influence on their school/life balance. Of the 37 respondents (from the 50 project participants), over 80% initially reported moderate to extreme stress, which decreased significantly post-activity, with 70% indicating a shift from no stress to only mild stress. The majority (over 80%) found the experience positive and advocated for its integration into the curriculum. Students expressed gratitude, noting improved overall well-being. The “Wellness Experience” exemplifies the integration of attentiveness to practitioner health of self into health professional curricula. Future oral health professionals must recognize that cultivating a proactive approach to well-being is paramount. It necessitates a departure from a reactive, disease-centric paradigm towards one that prioritizes holistic health promotion. Aligning with the Okanagan Charter Calls to Action, this entails embedding health consciousness into all university dimensions, imparting resources to the students, and recognizing selfcare’s educational significance.

Over the past couple of decades, there has been a focus on holistic care that highlights the struggles faced by vulnerable populations and those who are victims of trauma. The purpose of this systematic review was to summarize current research on the effectiveness of traumainformed care (TIC) in oral health care settings and to evaluate the use of TIC methodologies in general practice settings. Health inequities are prevalent throughout the world, and for those with complex post-traumatic stress disorder (PTSD) or a history of trauma, specialist care is not always easily accessible. A literature search was conducted in Scopus, PubMed/Medline, Web of Science, UBC, and Google Scholar to identify studies that explored the use of trauma-informed care for decreasing anxiety and treating patients with a history of trauma in health and oral health environments. Themes found throughout the literature included trauma screening/opportunity to disclose, identifying triggers, building a safe relationship, and the choice and control of the patient. These themes were explored and methodologies to use trauma-informed care were included. Research shows promise in the efficacy of TIC in an oral health care setting, as well as in other aspects of health care. There are further opportunities for research to evaluate a consistent TIC methodology, to see if there can be set standards for each patient, or if a unique, patient-centred approach is the best way forward.

Background: Dental plaque is a common issue that can be effectively managed with proper oral hygiene practices and regular oral health care. The aim of this crossover study was to assess dental plaque using different methods (digital and clinical plaque scores) and evaluate the effectiveness of toothbrushing with a triple-headed manual toothbrush compared to a single-headed manual toothbrush in removing dental plaque. Methods: Plaque staining was performed to assess dental plaque amounts before and after brushing with the triple-headed (test) and single-headed (control) manual toothbrush in 21 study participants after plaque was allowed to accumulate for 48 hours. Dental plaque was scored both clinically as well as digitally. Results: Toothbrushing with a manual single-headed toothbrush and a triple-headed toothbrush was found to be equally effective when comparing plaque removal ability. Brushing time was shorter when using a triple-headed toothbrush, compared to a single-headed toothbrush. Conclusion: The triple-headed manual toothbrush may be a good alternative to the single-headed manual toothbrush for certain patient groups.

Background: Presently, dental hygiene education is primarily divided into classroom lectures, simulation labs, and clinical experiences. Although the recent surge of curriculum renovation in dental and medical schools centres around enhancing student engagement and active learning, classroom teaching remains teacherfocussed, involving students mainly as passive learners. H5P is an open platform for creating and sharing interactive HTML5 learning content. A large set of H5P content was created and provided to students through the learning management system as supplementary material for an oral biology course in the dental hygiene program at a Canadian university. This study was conducted to evaluate the impact of this interactive H5P content on the students’ learning experiences. Methods: The third-year dental hygiene students enrolled in the oral biology course were invited to participate in the study. Anonymised student performance data from the summative exam were analysed, and a survey regarding the student experience with the supplementary H5P content was administered. Results: Students performed better on questions for which H5P supplements were provided. The results from the survey showed satisfaction and perceived benefit of using H5P as supplementary content in didactic lectures. Discussion: The H5P content allowed students to apply knowledge and reproduce understanding, promoting active learning in the didactic oral biology course. Students appreciated the content’s interactive nature and expressed willingness to have similar experiences in other courses. Conclusion: Using H5P, interactive learning content can promote self-directed and personalized learning. This open learning platform has the potential to redefine didactic teaching by fostering an active learning environment.

Objective: Oral lichen planus (OLP) is an immune-mediated condition featuring chronic inflammation. The World Health Organization classifies OLP as potentially malignant, but it is believed that the malignant transformation of OLP occurs in lesions with both lichenoid and dysplastic features (LD). This review discusses the issues surrounding OLP and LD, including their malignancy, classification, and categorization, and whether lichenoid inflammation causes dysplastic changes in LD or vice versa. Methods: English full-text literature on OLP, LD and/ or dysplasia was retrieved from PubMed, CINAHL, and Google Scholar. Results: Thirty-six publications including original research articles, reviews, meta-analyses, books, reports, letters, and editorials were selected for review. Discussion: Research suggests that OLP has malignant potential, although small, and that LD should not be disregarded, as dysplasia presenting with or without lichenoid features may develop into cancer. There is also disagreement over the classification and categorization of LD. Different terms have been used to classify these lesions, including lichenoid dysplasia, OLP with dysplasia, and dysplasia with lichenoid features. Moreover, in LD, it is not clear if dysplasia or lichenoid infiltration appears first, and if inflammation is a response to dysplasia or if dysplasia is a response to the persistent inflammation. The main limitation in the literature is the inconsistency and subjective nature of histological diagnoses, which can lead to interobserver and intraobserver variation, ultimately resulting in the inaccurate diagnosis of OLP and LD. Conclusion: Although further research is required to understand OLP and LD, both lesions should be considered potentially malignant and should not be disregarded.

Objective: Despite the vast knowledge gained through research and public health surveillance, dental caries prevalence among children from low-income households remains high. The aim of this literature review is to identify assumptions made within existing empirical, constructivist, and critical paradigms to determine how those assumptions impact knowledge and if these impacts have aided in perpetuating inequity or health disparities within this target population. Method: A literature search of EBSCOhost, PubMed, and Web of Science was conducted to retrieve articles from peer-reviewed journals published in the last 10 years, including qualitative, quantitative, and mixed methods studies. Qualitative methods included narrative research via interviews; quantitative designs included cross-sectional studies using surveys and various indices to assess oral health literacy (OHL) levels and oral health status. Exclusion criteria were non-English studies and studies that did not include female caregivers. Results: Nine primary research articles were selected for analysis. The positivist paradigm was dominant in 7 of 9 articles. Oral health social processes, such as the lack of value placed on oral health as a component of overall health by the broader medical community and the public, were not discussed as influencing factors on OHL. Discussion: Assumptions identified within the dominant paradigms were determined to perpetuate inequity or health disparities, confirming a link between caregivers’ OHL levels and the oral health status of their children. It is critical that all health care professionals improve their understanding of factors affecting caregivers’ OHL. Conclusion: Strategies that empower and advocate for women to improve their OHL should be developed.

Objective: Detecting oral lesions at high risk of becoming cancer may enable early interventions to prevent oral cancer. The diagnosis of dysplasia in an oral lesion is used to predict this risk but is subject to interobserver and intraobserver variability. Studying biomarkers or molecular markers that reflect underlying molecular alterations can serve as an additional and objective method of risk assessment. E-cadherin and beta-catenin, molecular markers of epithelial–mesenchymal transition (EMT), potentially contribute to early malignant progression in oral tissue. This narrative review provides an overview of EMT, its relation to oral cancer, and the interaction among E-cadherin, beta-catenin, and the Wnt pathway in malignant progression of oral tissue. Methods: Full-text literature on EMT, E-cadherin, beta-catenin, oral epithelial dysplasia, and oral cancer was retrieved from PubMed and Google Scholar. Results: Sixty original research articles, reviews, and consensus statements were selected for review. Discussion: EMT, a biological mechanism characterized by epithelial and mesenchymal changes, can contribute to cancer development. Molecular markers of EMT including TWIST, vimentin, and N-cadherin may serve as prognostic markers of oral cancer. Dependent on Wnt pathway activity and the loss of membranous E-cadherin, E-cadherin and beta-catenin can play various roles along the spectrum of malignant progression, including tumour inhibition, early tumour progression, and late-stage tumour progression. Cross-sectional immunohistochemical research has found changes in expression patterns of E-cadherin and beta-catenin from normal oral tissue, oral epithelial dysplasia, to oral squamous cell carcinoma. Conclusion: Future research should explore the longitudinal role of EMT markers in predicting malignant progression in oral tissue.

Introduction: Numerous clinical trials and systematic reviews have investigated the effectiveness of both herbal and conventional oral care approaches to reducing plaque and gingivitis. However, their findings vary and are inconsistent. Thus, the objective of this umbrella review is to compile data from systematic reviews and provide an overview of the effects of herbal oral care products on tooth plaque and gingivitis. Methods: A comprehensive search of the literature was performed in 6 databases for systematic reviews with or without meta-analyses, published up to 30 May 2023, without any language restrictions. Only clinical trials comparing herbal oral care products (in the form of mouthrinse or toothpaste) against standard oral care products or placebo were considered. Results: Some herbal oral care products, particularly in the form of mouthrinses, have a similar level of positive effect on plaque and gingivitis reduction and, thus, can be used as an adjunct to traditional dentifrices. However, the shorter duration of trials (<4 weeks) and reported publication bias in the clinical trials mean that these findings must be interpreted with caution. Conclusion: To accurately determine the impact of various herbal extracts on periodontal health, well-designed, long-term, and controlled trials that adhere to standardized protocols must be carried out.

Introduction: Peripheral ossifying fibroma (POF) is a solitary gingival growth thought to arise from the gingiva, periosteum or the periodontal ligament. It is a slow-growing, benign, progressive lesion that is limited in size. Case description: This article describes a case of ossifying fibroma of a peripheral variant that occurred in a 26-year-old female in the anterior region of the lower jaw and presented as a growth on the gingiva. Since it was difficult to diagnose clinically, a pathological evaluation was mandatory. Upon pathological confirmation of the diagnosis, the lesion was surgically excised up to the periosteum. This was deemed to be the required treatment yet, since the recurrence rate is high for POF (8% to 20%), the patient must be followed up yearly to check for recurrence.

Purpose: In recent years, Canada has seen the development of new educational pathways to baccalaureate education for dental hygienists. Research has demonstrated that degree education strengthens dental hygienists’ cognitive and practice abilities and increases career opportunities. However, the 2021 Canadian Dental Hygienists Association (CDHA) Job Market and Employment Survey reported that only 27% of respondents held a baccalaureate degree. The current study was the first to explore levels of interest in and barriers to pursuing degree education among Canadian diploma-holding dental hygienists. Methods: This qualitative explorative study utilized purposeful maximum variation sampling to select Canadian dental hygienists across 10 provinces and 1 territory for 3 e-focus groups. Selected participants (N = 17) were CDHA members who held a dental hygiene diploma as their highest educational credential. E-focus groups were thematically analysed for barriers using Saldaña’s descriptive and in vivo coding. Results: All participants expressed an interest in pursuing further education at some point during their career. Reported barriers to doing so were family commitments, financial restrictions, accessibility, limited employer support, unfamiliarity with eligibility criteria, unfamiliarity with existing programs, stress/anxiety over returning to school, and unfamiliarity with the benefits of earning a degree. Conclusions: The qualitative research findings supplemented answer options for a subsequent national online research survey distributed to all CDHA members; results of that survey are not included in this article. National and provincial dental hygiene associations and educational institutions can use the study findings to develop strategies to reduce barriers and raise awareness of degree education among Canadian dental hygienists.

Background: The high demand for oral health care services among vulnerable individuals combined with limited available resources requires a rethinking of the provision of oral health services. This study aimed to determine the usefulness of the dental panoramic radiograph (DPR) as an imaging tool to assess oral health and prioritize dental interventions in vulnerable patients. Methods: This observational and retrospective study evaluated charts of patients who attended Public Health Dental Clinics (PHDC), Alberta Health Services (AHS), in Calgary, Canada, between January 2018 and December 2019. Data collected included sex and age at the time of image acquisition. The following radiographic findings were gathered: the number of missing, present, decayed, restored, and impacted teeth; periapical lesions; retained root; periodontal bone loss; odontogenic and non-odontogenic lesions in the jaws; carotid calcification; and incidental radiographic findings with clinical relevance. Results: Of the 526 DPRs evaluated, 57.4% were from male patients and 42.6% were from female patients, with a mean age of 38.5 years. The average number of present teeth in females and males was 23.7 and 22.6, respectively. The most prevalent dental-related finding was periodontal bone loss (81.5%), followed by periapical lesions (59.6%) and impacted teeth (27%). Among non-dental findings, osseous lesions of the jaws were found in 10.4% of the patients, and carotid atheroma had a frequency of 3.2%. Conclusion: The DPR is a useful adjunct to the clinical exam in this specific population. It provides an opportunistic overview of their oral health and necessary support to establish priorities in oral health care in a public health setting.

Background: Community service-learning (CSL) aims to promote civic engagement among students and deepen their understanding of social issues, connecting students to communities where they may practise as future health care providers. This study’s aims were two-fold: first, to determine whether incorporating a nondental community service-learning experience into a fourth-year behavioural science course can develop abilities related to the dental hygiene baccalaureate competencies; second, to examine the overall student learning experience. Methods: Seven community agencies presented projects to the dental hygiene class, and students individually selected their top 3 choices. Projects were diverse, ranging from literacy tutoring to creating a program plan or hosting a public virtual event with an interprofessional health panel discussing nutrition. Dental hygiene students participated in a 20-hour placement with one community project and completed individual reflection journals that focused on their experience. Using a document analysis approach, the authors examined the reflection journals through an iterative process to identify themes. Results: Ten student reflections were analysed and three themes emerged: 1) increased social awareness; 2) application of dental hygiene core competencies; and 3) the challenges of the learning experience. Students consistently discussed how the project allowed them to apply 5 dental hygiene core competencies and how their learning experience aligned with their future professional role as a dental hygienist. Students articulated increased understanding of their individual privilege and awareness of social issues in their community. Conclusions: Participation in non-dental CSL increased dental hygiene students’ social awareness of local communities. Students demonstrated an ability to apply their learning to their developing competencies as future dental hygienists.

Background: Immigrants to Canada count among the socially disadvantaged groups experiencing higher rates of oral disease. Culturally competent oral health care providers (OHCPs) stand to be allies for immigrant oral health. The literature reveals limited knowledge of practising OHCPs’ cultural competency, and little synthesis of the topic has been completed. A scoping review is warranted to identify and map current knowledge of OHCPs’ understanding of culturally competent care along with barriers and facilitators to developing capacity. Methods: This study was conducted between December 2022 and April 2023 using Arksey and O’Malley’s 5-step framework and PRISMA-ScR checklist. Four databases were searched using keywords related to 4 themes: population, provider, oral health, and cultural competence. Peer-reviewed articles published in English in the last 10 years were included. Results: Search results yielded 74 articles. Title and abstract review was completed and an author-developed critical appraisal tool was applied. Forty-six (46) articles were subject to full-text review and 14 met eligibility criteria: 7 qualitative and 7 quantitative. Six barriers and six facilitators at individual and systemic levels were identified, affecting oral care for immigrants and providers’ ability to work cross-culturally. Discussion: Lack of cultural or linguistically appropriate resources, guidance, and structural supports were identified as contributing to low utilization of services and to lack of familiarity between providers and immigrants. Conclusion: OHCPs’ cultural competency development is required to improve oral health care access and outcomes for diverse populations. Further research is warranted to identify factors impeding OHCPs’ capacity to provide culturally sensitive care. Intentional policy development and knowledge mobilization are needed.

Background: Since the outbreak of COVID-19, how to reduce the risk of spreading viruses and other microorganisms while performing aerosolgenerating procedures (AGPs) has become a challenging question within the dental and dental hygiene communities. The purpose of this position paper is to summarize the evidence of the effectiveness of various mitigation methods used to reduce the risk of infection transmission during AGPs in dentistry. Methods: The authors searched 6 databases—MEDLINE, EMBASE, Scopus, Web of Science, Cochrane Library, and Google Scholar—for relevant scientific evidence published between January 2012 and December 2022 to answer 6 research questions about the risk of transmission, methods, devices, and personal protective equipment (PPE) used to reduce contact with microbial pathogens and limit the spread of aerosols. Results: A total of 78 studies fulfilled the eligibility criteria. The literature on the risk of infection transmission including SARS-CoV-2 between dental hygienists and their patients is limited. Although several mouthrinses are effective in reducing bacterial contaminations in aerosols, their effectiveness against SARS-CoV-2 is also limited. The combined use of eyewear, masks, and face shields is effective in preventing contamination of the facial and nasal region while performing AGPs. High-volume evacuation with or without an intraoral suction, low-volume evacuation, saliva ejector, and rubber dam (when appropriate) have shown effectiveness in reducing aerosol transmission beyond the generation site. Finally, the appropriate combination of ventilation and filtration in dental operatories is effective in limiting the spread of aerosols. Discussion and Conclusion: Aerosols produced during clinical procedures can pose a risk of infection transmission between dental hygienists and their patients. The implementation of practices supported by available evidence will ensure greater patient and provider safety in oral health settings. More studies in oral health clinical environments would shape future practices and protocols, ultimately to ensure the delivery of safe clinical care.

Introduction: Alveolar oral exostosis is a common, benign condition routinely found in dentistry. Clinical problems associated with exostoses are the maintenance of oral hygiene as well as the fabrication of prosthodontic appliances. Over time, exostoses may contribute to irritation and periodontal disease. Case description: The patient in this case study had a recurrence of exostoses and was bothered by consistent and prominent pain. She reported being a bruxer; her bruxism was exacerbated due to attention-deficit hyperactivity disorder and antidepressant medications. Discussion: The etiology behind the recurrence of exostosis is discussed. The most evident etiology seems to be persistence of medication-induced bruxism, specifically awake bruxism. Conclusion: It is necessary to take a proper history to identify the cause of the recurrence of exostosis. Dental hygienists can contribute to a better understanding of and provide better treatment options for patients who have medication-induced bruxism.

Letter to the Editor

Background: Stress is a challenge to many post-secondary students and, if prolonged and unmanaged, can affect academic success. Understanding factors that contribute to students’ stress is important. One possible contributor may be adverse childhood experiences (ACEs); that is, traumatic events that occur during the first 18 years of life. Inverse relationships between the number of ACEs and indicators of poor mental well-being have been proposed. Objective: To describe ACEs in oral health students (OHS) and the associations between the number and types of ACEs and levels of perceived stress, an indicator of mental well-being. Methods: Invitations to participate in an anonymous online cross-sectional survey were sent to all OHS, 19 years and older, attending Dalhousie University in Halifax, Nova Scotia, Canada. Self-reports of ACEs and perceived stress were collected. Zeroorder correlations and regression modelling were used to examine associations. Results: Twenty-six percent (26%, n = 66) of OHS completed the survey. Respondents reported an average of 2.20 ACEs; 34.9% reported >3 ACEs. Emotional abuse (41%) was the most reported ACE. Associations were observed between numbers of ACEs and stress. Levels of stress increased with the number of ACEs (r = 0.23, p < 0.05). Regression modelling determined levels of stress were not affected by ACE type (F(3,62) = 2.24, p = 0.092). Discussion: This was the first study to examine associations between ACEs and perceived stress in OHS. These students reported greater numbers of ACEs than age-matched general populations. Levels of stress were associated with numbers of ACEs. Conclusion: Faculty in dental and dental hygiene programs should recognize the prevalence of ACEs among OHS and the potential impact on their mental well-being.

Background: Lack of knowledge about transgender patients often correlates with increased stigma and an unwillingness to provide care to this population. This study examined the knowledge, attitudes, and willingness of oral health care providers with regard to treating transgender patients. Methods: Dentists, midlevel providers, and dental hygienists in the United States and Canada accessed an online survey (N = 315) focused on assessing knowledge, attitudes, and willingness to provide care and/or seek additional education on treating transgender individuals. Descriptive statistical, correlational, and regression analyses were conducted. Results: The survey completion rate was 85% (n = 268). Respondents correctly answered an average of 70% of the knowledge questions, with 56% of participants unable to define “gender” and 66% unable to define “sex identity”. Almost 1 in 4 respondents incorrectly defined a trans male or trans female, or misidentified particular health disparities experienced by transgender individuals. A lack of willingness to seek additional information on providing culturally competent care, having lower levels of knowledge, and identifying with specific religions correlated with higher levels of stigma (p < 0.001). While US providers exhibited low stigma overall, Canadian providers, survey respondents with higher levels of knowledge, and those with transgender friends and/or family demonstrated lower levels of stigma (p < 0.001). Discussion and conclusions: Transgender individuals face disparities in medical and oral health care. Based on the findings of this survey, it will be important to address factors associated with higher levels of stigma and educate oral health professionals on providing culturally competent care for transgender individuals.

Background: Musculoskeletal disorders (MSDs) are highly prevalent among dental hygiene professionals. The purpose of this pilot study was to evaluate and compare seated and standing postures during simulated dental hygiene practice to determine ergonomic risks associated with each posture. Methods: A convenience sample of 35 female second-year dental hygiene students with no history of musculoskeletal disorders was enrolled in this IRB-approved study. In 2 separate sessions, 1 seated and 1 standing, participants instrumented 1 quadrant of the mouth in a simulated oral environment. Two images per session, per participant, were taken to evaluate biomechanical demands of each posture using the Rapid Upper Limb Assessment (RULA) tool. The same 4 calibrated researchers scored all images independently and mean scores for each posture were analysed. Results: Thirty-four students completed the study. Results revealed statistically significant (p = 0.001) differences in mean RULA scores between seated (M = 3.91, SD = 0.77) and standing (M = 4.50, SD = 1.00) postures, although these differences may not be clinically relevant. Discussion: When postures were independently assessed, seated postures were more acceptable on average compared to standing postures, yet both were in the unacceptable range. Lack of training in standing postures may have impacted the results. Conclusion: Results support the need for additional ergonomic training in dental hygiene curricula. Less than ideal posture when seated or standing could increase MSD risk. Future research should examine biomechanical loads of seated and standing postures, as well as the combination of these postures, for more insight into their ergonomic benefits and associated MSD risks.

Background: Nursing home-acquired pneumonia (NHAP) is the leading cause of mortality among residents in long-term care (LTC) homes. Aspiration pneumonia (AP) is one cause of NHAP. Professional oral health care (POHC) and daily mouth care can be effective in decreasing AP risk. Aim: To identify, appraise, synthesize, analyze, and interpret results on the effectiveness of onsite POHC interventions/programs delivered to LTC home residents in reducing oral disease and NHAP. To summarize the findings and provide recommendations for clinical work and future research. Methods: The PICO question addressed was, “In LTC home residents with oral health needs (P), is onsite POHC (I), compared to usual care (C), clinically effective in reducing dental disease and pneumonia/AP (O)?” Databases searched were PubMed, EMBASE (Ovid), CINAHL (Ebsco), Cochrane Library (Wiley), Web of Science, and the databases of the Centre for Reviews and Dissemination. Included were randomized controlled trials (RCTs), non-RCTs, and cross-sectional studies. PRISMA guidelines were followed and GRADE was used to assess the quality of studies. Results: Thirteen clinical effectiveness studies were included: 10 RCTs, 1 non-RCT, and 2 cross-sectional studies. Discussion: Better oral health and respiratory infection outcomes were found in the experimental groups who received an onsite POHC intervention compared to the control groups. Conclusion: There is moderate-to-strong evidence that onsite POHC in LTC homes, provided mostly by dental hygienists, is effective in preventing bacterial mouth infection, pneumonia, and AP.

Objective: This narrative review explores current research to broaden the understanding of dental hygienists’ experiences and satisfaction in the workplace while suggesting strategies for the retention of dental hygienists and examining how current staffing shortages may impact the forthcoming Canadian Dental Care Plan. Methods: An electronic literature search was conducted in the following online databases: PubMed, Google Scholar, CINAHL, and Education Source. Only full-text, peer-reviewed articles written in English were selected for review. Results: The search yielded 18 articles with a wide range of study designs and methodologies. Discussion: Five key themes emerged from the literature: health impacts, psychosocial environment, strategies for retention, contradictory findings, and implications for the Canadian Dental Care Plan. Conclusion: Dental hygienists experience many health, environmental, and psychosocial challenges in their day-to-day working life that affect their job satisfaction and overall willingness to remain in the profession. Strategies for retention are essential for maintaining the current dental hygiene workforce and can have a positive impact on the Canadian Dental Care Plan and its success.

Introduction: Higher educational institutions increasingly focus on incorporating games to enhance student engagement. Gimkit is a recent addition to gamified learning that allows instructors to create quiz games with randomly repeated questions. Case description: The study of nutrition requires memorization of facts. Gimkit was incorporated into a dental hygiene class to teach nutrition and support rote learning. Anonymous data on student performance and satisfaction were collected. Descriptive statistics were applied to summarize the survey results; the difficulty and discrimination indices were analyzed to evaluate students’ academic performance. Results: Ten percent of the class participated in the voluntary survey; academic performance was analyzed for the whole class. The study identified Gimkit as a potential learning tool, especially for content areas that require memorization and learning of facts. Conclusion: Data show a positive impact of in-class gaming on knowledge acquisition and retention.

Aim: To evaluate the impact of online social networks (OSN) as resources for promoting behaviour changes related to the prevention and promotion of oral health. Methods: This was a systematic review with meta-analysis of randomized clinical trials identified in databases (MEDLINE/Embase/Lilacs), published up until May 2022, and prepared according to Cochrane recommendations. Studies that used OSN (WhatsApp®, Telegram®, TikTok®, Facebook®, Twitter®, YouTube®, Instagram®, Soundcloud®, Flickr®, LinkedIn®, and Webradio®) were included. The protocol was registered in the International Prospective Register of Systematic Reviews (CRD42021248045). Results: In total, 3171 studies were evaluated, of which 12 studies met the inclusion criteria for the review and contained data on 1669 participants. The most frequently investigated OSN were WhatsApp®, followed by Telegram®, and YouTube®. All studies included were at high risk of bias. Data extraction allowed the meta-analysis of gingival index (GI) and oral health knowledge (OHK) outcomes for young people. Findings revealed that young people exposed to digital interventions via OSN showed a reduction in GI when compared with traditional educational interventions. This reduction occurred in all young people (standardized mean difference, –0.48; 95% CI, –0.75 to –0.21; p = 0.0006, I2 = 0%; very low certainty), including those who were undergoing orthodontic treatment (standardized mean difference, –0.58; 95% CI, –0.92 to –0.24; p = 0.0008, I2 = 0%; very low certainty). Furthermore, young people undergoing orthodontic treatment and exposed to OSN showed an increase in OHK when compared with participation in traditional educational interventions (standardized mean difference, +0.86; 95% CI, +0.46 to +1.26; p < 0.0001, I2 = 0%; very low certainty). Conclusion: OSN could be effective tools for improving oral health outcomes in young people.

Background: In March 2020, COVID-19 public health restrictions impeded inperson clinical assessment. In response, a dental hygiene program administered a virtual objective structured clinical exam (vOSCE) using Zoom to assess student competency in performing a health history. This study aimed to explore the vOSCE experience from both student and clinical instructor perspectives. Methods: This 2-part cross-sectional study gathered student and clinical instructor perceptions of the vOSCE. Forty-two students were invited to complete an online questionnaire. Basic descriptive statistics reporting percentages were tabulated. Twelve clinical instructors were invited to participate in focus groups, which were audiorecorded and transcribed verbatim. Qualitative data were analysed using inductive thematic analysis. Results: Questionnaires were received from 23 (55%) students. Students supported (91%) the vOSCE experience and believed it assessed their knowledge (87%), their ability to complete a health history (91%), and ability to communicate effectively (87%). Students reported high agreement (87%) with how the Zoom platform facilitated the examination. Some students (35%) felt the vOSCE was more stressful than an in-person OSCE. However, 43% indicated it wasn’t more stressful. Focus groups with clinical instructors revealed perspectives on using vOSCEs, which were captured under 4 themes: preparation, assessment suitability, authenticity, and future considerations. Conclusion: Based on student and instructor perspectives, vOSCEs could be a viable alternative to in-person OSCEs for health history evaluations. As technology applications continue to emerge for conducting virtual examinations, there may be increased use of and ease of use with a virtual platform to conduct other types of clinical evaluations.

Background: Attention-deficit/hyperactivity disorder (ADHD) contributes to functional impairments in the performance of personal tasks such as oral hygiene. This study aimed to compare oral health behaviours and consumption of cariogenic foods in children diagnosed with ADHD and healthy control peers. Methods: In this cross-sectional study, 60 children with ADHD aged 6 to 11 years made up the study group, and 60 peers of the same age, sex, and from the same school, without a history of ADHD, made up the control group. To compare the parent-reported behaviours between the 2 groups, conditional logistic regression was used to obtain matched pairs odds ratios (ORs) and 95% confidence intervals (CI). Results: Children with ADHD were 0.4 times less likely than their non-ADHD peers to brush their teeth at least once a day (OR = 0.40, 95% CI: 0.18–0.91, p = 0.028). Moreover, compared to the control group, children with ADHD were 4.71 and 9.67 times more likely to consume cariogenic foods (95% CI: 2.08—10.66, p < 0.001) and drinks (95% CI: 2.94–31.73, p < 0.001), respectively, at least thrice a day. Conclusion: In comparison to their non-ADHD peers, children diagnosed with ADHD were less likely to brush their teeth and simultaneously more likely to consume both cariogenic foods and drinks.

Background: The Student Health Initiative for the Needs of Edmonton (SHINE) dental clinic is a student-volunteer-operated clinic offering free oral care to lowincome individuals. However, little is known about how SHINE impacts access to care. Drawing on Penchansky and Thomas’ theory of access, this study assessed patient satisfaction to measure access. For further context, patient-reported oral health concerns and alternative oral care options if SHINE were not available were recorded. Methods: The University of Alberta’s Research Ethics Board (Pro 00101981) approved the study. Surveys adapted from Penchansky and Thomas were distributed over 12 weeks to all presenting patients. Survey data were triangulated with observations. Data were represented using descriptive statistics, and variables were compared using Chi-squared tests of independence. Results: A response rate of 77% (140/170) was achieved. The survey revealed that patients were generally satisfied with access to SHINE. However, observations revealed physical accessibility barriers. Dissatisfaction was correlated with attending SHINE without receiving treatment. Patients primarily presented to SHINE for pain (55%, 76/139). If SHINE were not available, 38% (46/121) of patients reported they would seek care from an alternative oral health professional, 32% (39/121) through an emergency department or physician, and 27% (33/121) would not attain oral health care at all. Conclusion: SHINE could be seen as addressing the need for access to oral health care services. The remaining barriers to care include long waiting times and clinic capacity to deliver care. A faster triage process may reduce waiting times. However, SHINE cannot provide more oral health care due to clinic capacity. Lastly, access to clinics such as SHINE may reduce visits to emergency departments for oral health care.

Background: Charcoal-based preparations have recently gained popularity, particularly in oral hygiene products such as tooth whitening dentifrices, owing to their abrasive and adsorptive properties. The present in vitro study evaluates the efficacy of a charcoal-based tooth whitening dentifrice compared with a non-charcoal-based whitening dentifrice in removing coffee stains on tooth surfaces. Methods: Thirty-three human extracted tooth specimens were randomly assigned to 1 of 3 study groups: Group 1 (charcoal-based whitening dentifrice [CBWD]), Group 2 (non-charcoal-based whitening dentifrice [NCBWD]), and Group 3 (distilled water [DW]). All tooth specimens were immersed in a prepared coffee extract for 4 weeks to facilitate staining and then mounted on blocks where they were brushed with an electric toothbrush daily for 8 seconds with 1 of the 2 allocated dentifrices or with DW for 4 weeks following staining. Spectrophotometric analysis was conducted using the CIELAB system to measure the L*, a*, and b* values at 3 time points: before staining, after staining, and following the brushing protocol. These values were used to calculate the colour change (?E) between time points. Results: Following the coffee staining, the tooth samples’ whiteness (?L) decreased with the overall colour change (?E). Next, there was a significant improvement in the degree of tooth whiteness (?L) values following the brushing protocol in all 3 groups (p = 0.003), with the greatest improvement occurring in the CBWD group. However, the overall colour change (?E) was not significantly different between the groups. Conclusion: CBWD, NCBWD, and DW were effective in removing coffee stains from the tooth surface. However, the amount of colour change (?E) produced by CBWD was not significantly different from NCBWD or DW.

Lobodontia is a rarely documented dental condition associated with pointed or conical cusps on premolars and canines, multitubercular occlusal surfaces on molar teeth, and irregularly shaped incisors. Information on this uncommon condition continues to be scarce, with particularly little information available on the primary dentition. The purpose of this article is to describe 6 cases of lobodontia and discuss the variability in presentation and management. Previously unreported manifestations in the primary dentition are included. The cases described in the current study demonstrate the spectrum of clinical and radiographic features of the condition, and show that a varied, individualized approach to treatment is necessary.

Background: Supragingival air polishing of teeth effectively removes dental plaque and extrinsic stain on coronal tooth surfaces, but its impact on specific periodontal pathogens in adjacent subgingival biofilms is not known. This study assessed the microbiological effect of supragingival air polishing on the subgingival microbiota of individuals with severe periodontitis. Methods: Supragingival air polishing with a sodium bicarbonatebased powder was performed on 15 adult test subjects, with the nozzle of the air polishing device aimed apically at a 45° angle onto tooth surfaces immediately coronal to the entrance of periodontal pockets. Supragingival prophylaxis paste polishing, using a slow-speed handpiece, was carried out on 13 adult control subjects. Subgingival specimens were collected from a single 5 mm to 7 mm periodontal pocket with bleeding on probing in each of the study participants before and immediately after supragingival polishing procedures. Viable bacterial counts and selected putative periodontal pathogens (Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia/nigrescens, Fusobacterium nucleatum, Parvimonas micra, Campylobacter species) were quantified by microbial culture, and motile morphotypes (spirochetes and motile rods) by phase-contrast microscopy. Results: Statistically significant decreases were detected after supragingival air polishing in total viable counts (84.9% decrease), in P. intermedia/nigrescens, F. nucleatum, Campylobacter species, total proportions of red/orange complex periodontal pathogens (82.3% decrease), and in motile morphotypes (85.3% decrease). No statistically significant subgingival microbiological changes occurred with supragingival prophylaxis paste polishing. Conclusion: Supragingival air polishing of teeth, but not supragingival prophylaxis paste polishing, may serve as a useful therapeutic adjunct to disrupt and help remove pathogenic biofilms in deep periodontal pockets.

Background: As discussions about baccalaureate education for dental hygiene continue at national and international levels, examining outcomes of earning a baccalaureate degree in a Canadian context is essential. This study aimed to explore the motivating reasons for pursuing a dental hygiene baccalaureate degree in Canada and the career outcomes of Canadian dental hygiene baccalaureate degree graduates. Methods: Graduates from all 4 Canadian dental hygiene degree programs (N = 262) participated in a cross-sectional online survey between November and December 2021. Survey questions explored motivating reasons for pursuing dental hygiene degree education, educational experiences, employment outcomes, and career satisfaction. A descriptive analysis was performed to report absolute and relative frequencies of responses to each question. Differences between participant characteristics, motivating reasons for pursing a degree, and practice outcomes were assessed. Where applicable, results were compared to the results of the Canadian Dental Hygienists Association's 2019 Job Market and Employment Survey. A thematic analysis was applied to open-ended descriptive responses. Results: Primary motivators included personal satisfaction (77%), status of a degree (75%), increase in employment opportunities (71%), and increase in knowledge base (69%). Respondents (87%) reported that they were satisfied with their educational experiences, and the majority (65%) agreed that a degree should be the minimum entry-level credential for dental hygiene practice in Canada. Primary practice settings were reported as clinical dental hygiene care (80%), educational institutions (9%), community and public health (4%), and other practice settings (7%). A larger proportion reported working in non-clinical settings than those in the national survey (20% and 8%, respectively; p < 0.001). Conclusion: These findings underscore the impact of baccalaureate education on dental hygiene practice in Canada.

Background: Acidulated phosphate fluoride (APF) application is used for dental caries prevention. Combining APF with different laser wavelengths increases acid resistance in enamel. Aim: To assess the effects of Er:YAG (2940 nm) laser and diode (940 nm) laser after the application of APF on morphology and mineral content of enamel surfaces of human teeth in vitro. Materials and Methods: Twenty (20) freshly extracted third molar crowns were collected and split longitudinally into halves. Ten (10) halves were given to each of the following groups: group 1 (control), group 2 (application of 1.23% APF gel only), group 3 (diode laser; 1 W for 60 sec, contact mode after APF gel), and group 4 (Er:YAG; 80 mJ, 0.8 W, 10 Hz; in pulsed mode for 10 sec after APF gel). Specimens were morphologically examined by scanning electron microscope (SEM), and mineral content was analysed by energy dispersive X-ray (EDX). Collected data were statistically analysed by ANOVA. Results: Morphologic results were superior in group 3 followed by group 2 and group 1 with the least change in group 4. EDX of calcium (Ca), phosphorous (P), and Ca/P ratio weight % showed the highest value with no statistical significance between groups 2 and 1, and higher with statistical significance in groups 3 and 4 in descending order. Carbon weight % showed highest results in group 4 then 3, 2, and 1. Fluoride weight % showed highest statistical results in group 4 then 2, 3, and 1. Conclusion: The diode laser showed superior morphological results after APF application compared to the Er:YAG laser. The Er:YAG increased fluoride absorption on outer enamel surfaces.

Background: Immigration has accounted for three-quarters of Canada’s population growth since 2016, more than half of which has been from Asian countries. Newcomers from Asia have been reported to experience oral health disparities. The objective of this scoping review was to examine the literature discussing how culture affects access to oral health care for new immigrants from Asia and to identify knowledge gaps. Methods: The review was conducted from December 2021 to April 2022 following the Arskey and O’Malley approach and PRISMA-ScR guideline. Five databases were searched using the search parameter “Asian+ AND Immigrant+ AND oral care+”. Only peer-reviewed articles published in English between 2011 and 2021 were included. Results: The search strategy yielded 736 articles. Duplicates were removed, titles and abstracts were reviewed, and the full text of 69 articles examined, leaving 26 articles that met eligibility criteria: 18 quantitative studies, 4 qualitative studies, and 4 reviews. Discussion: Four themes were identified: language barriers, oral health care access and service utilization, oral health beliefs and behaviour, and immigrant children’s oral health. Most new immigrants from Asia have limited English proficiency, are of low socioeconomic status, and have difficulty developing trusting relationships with care providers. Immigrant children’s oral health is impacted by their parents’ beliefs. Conclusion: More research is needed on cultural barriers to and facilitators of access to oral health care for newcomers from Asia to Canada to aid in the development and implementation of policies and to inform practice and curriculum.

Objective: The objective of this narrative review is to determine if periodontal disease is a factor in the development of a poor prognosis for COVID-19. Method: A bibliographic search was conducted in PubMed, Virtual Health Library, Google Scholar, and in the databases of Science Direct, Scopus, Lilacs, Bireme, Scielo, and Web of Science, using the following keywords: “COVID-19,” “SARS-CoV-2,” and “periodontal diseases.” Results: Fifty-six records were retrieved from the database searches. After screening, 39 articles were selected for study: 13 reviews, 2 case–control studies, 1 systematic review, 8 letters to the editor, 2 cohort studies, 1 thesis, 7 hypotheses, 1 short communication, 3 commentaries, and 1 scoping review. Discussion: Both periodontal disease and COVID-19 produce an inflammatory response. This immune response generates an over-production of inflammatory cytokines that can harm overall health. Conclusion: The mouth serves as the entryway for many microorganisms that can harm health in general, among them SARS-CoV-2. It is important to maintain good oral health to lower the inflammatory load present in periodontal disease, lessening the possibility of complications from COVID-19.

Background: Research has suggested 2 potential mechanisms by which the periodontal inflammatory response may communicate to distant organs: 1) direct translocation of periodontal bacteria from the oral cavity to another organ system; and 2) inflammation as a result of metastatic periodontal inflammation. The purpose of this scoping review is to explore these mechanisms as potential mediators between periodontitis and Alzheimer’s disease. Methods: A reiterative literature search of peer-reviewed articles was performed in the PubMed and Scopus databases using keywords or combinations such as Alzheimer’s disease AND periodontitis OR periodontal disease AND inflammation. Results: A total of 777 articles were identified. After eliminating duplicates and reviewing titles and abstracts, 84 articles were selected for full-text review. Following full-text review, 19 articles met the eligibility criteria for the study. Discussion: The review of the literature highlights how periodontitis may contribute to neuroinflammation by the introduction of periodontal bacteria and/or proinflammatory cytokines locally produced at the periodontium. Conclusion: Inflammation is an important mechanism in the onset and progression of both periodontitis and Alzheimer’s disease. Nevertheless, further studies are necessary to better understand the multifactorial pathogenesis of Alzheimer’s disease.

Purpose: To demonstrate the effect of an orofacial myofunctional therapy intervention by an interdisciplinary team composed of a registered dental hygienist who is also a certified orofacial myologist (COM®), a general dentist, and an orthodontist on the elimination of oral habits and changes in dental malocclusion. Method: This case study describes a 7-year-old female who underwent an individualized myofunctional therapy program and was given supervised education on a series of exercises targeting the muscles of mastication and facial expression over 5 months. Correct oral rest postures of the tongue and the lips were also established through therapy. Results: The intervention enabled the client to eliminate multiple oral habits, which corrected oral rest postures of the lips and tongue. This correction consequently improved the client’s malocclusion and further prepared the client for future orthodontic treatment. Conclusion: Myofunctional therapy facilitated the elimination of unfavourable oral habits that led to malocclusion. Eliminating oral habits better prepared the client for orthodontic treatment and retention. Use of an interdisciplinary team facilitates optimal client care.

Background: Ultrasonic instrumentation (USI) has evolved, but it is unclear if dental hygiene curricula have kept pace. This study compares 2 dental hygiene cohorts with differing USI curricula to investigate if a contemporary USI curriculum enhanced students’ USI preparation, use, and confidence. Methods: A 2-group observational study compared a “traditional” USI curriculum (TC) cohort to a later “contemporary” USI curriculum cohort (CC). The new curriculum introduced USI earlier, with more and different inserts, and greater USI philosophical emphasis. Questionnaires were administered to students at the onset (T1) and conclusion (T2) of clinical programming. Ethical approval was received from the Multi-College Ethics Review Process. Statistical calculations included frequencies, proportions, means, and Welch’s 2-sample, 2-tailed t-test statistics describing and comparing the cohorts’ preparation, use of, and confidence in USI (significance threshold 0.05). Results: Sample size fluctuated due to student attrition; response rate ranged from 21.5% (17/79) to 52.9% (36/68). Earlier in programming, CC students were significantly more prepared with water control, fulcruming, and curved inserts than TC students. No significant differences emerged between groups in use of ultrasonic versus hand instruments (USI approximately 60% of clinical time; p > 0.05). Initially, TC students had significantly greater confidence than CC students (p < 0.05). While there was no difference between groups at Time 2, CC cohort’s confidence increased statistically significantly from T1 to T2 (p < 0.05). Discussion & Conclusions: Both cohorts demonstrated similar use of USI. The CC cohort was better prepared in some aspects of USI and use of curved inserts. Results reveal an ongoing need for program evaluation to best implement USI curriculum.

Background: Oral health care settings potentially carry a high risk of cross-infection due to close contact and aerosol-generating procedures. There is limited evidence of the impact of COVID-19 among dental hygienists. This longitudinal study aimed to 1) estimate COVID-19 incidence rates among Canadian dental hygienists over a 1-year period; and 2) estimate vaccination rates among Canadian dental hygienists. Methods: A prospective cohort study design was used to collect self-reported COVID-19 status from 876 registered dental hygienists across Canada via an online baseline survey and then 6 follow-up questionnaires delivered between December 2020 and January 2022. Bayesian Poisson and binomial models were used to estimate the incidence rate and cumulative incidence of self-reported COVID-19. Results: The estimated cumulative incidence of COVID-19 in dental hygienists in Canada from December 2020 to January 2022 was 2.39% (95% CrI, 1.49%–3.50%), while the estimated cumulative incidence of COVID-19 in corresponding Canadian provinces was 5.12% (95% CrI, 5.12%–5.13%) during the same period. At last follow-up, 89.4% of participants self-reported that they had received at least 1 dose of a COVID-19 vaccine. Conclusion: The low infection rate observed among Canadian dental hygienists between December 2020 and January 2022 is reassuring to the dental hygiene and general community.

Objective: This narrative review explores current research to broaden understanding and awareness of the transgender experience while identifying oral health needs and proposing strategies of inclusivity to optimize oral health outcomes. Methods: A comprehensive electronic literature search was conducted in the following online databases: PubMed, Google Scholar, CINAHL, and Education Source. The search yielded 35 articles with a wide range of study designs and methodologies. Results & Discussion: Several themes emerged from the literature, including psychosocial oral health implications, barriers to oral health care, inclusive dental practice strategies, and cultural competence of oral health providers. Conclusion: The transgender population experiences many social and health disparities that stem from discrimination. Systemic inequalities, coupled with other barriers to care, have significant oral health implications for this population. Implementing inclusivity strategies and gaining awareness of the transgender experience will contribute to better oral health outcomes in this community.

Objective: This narrative review aims to compile and analyse infection prevention and control (IPAC) practices followed by dental clinics during 3 coronavirus outbreaks: SARS (2002–2004), MERS (2012–2014), and COVID-19 (2019–); and to draw parallels from them for future epidemics. Methods: Data were collected from 3 databases: Google Scholar, PubMed, and Embase using search terms “SARS,” “MERS,” “COVID-19,” “infection control,” “disinfection,” and “sterilization”. Results: Careful examination of 108 peer-reviewed articles on the 3 outbreaks revealed the following commonalities in the IPAC practices of dental clinics: use of sodium hypochlorite (surface disinfectant), ethanol and 1-propanol (hand hygiene), povidone-iodine (oral rinse), high-volume evacuation (HVE), rubber dam isolation, anti-retraction handpieces, and fogging. Discussion & Conclusion: Ethanol, 1-propanol, sodium hypochlorite, povidone-iodine, photocatalysis, and fogging have been shown to be effective against various coronaviruses. However, more studies are required to validate the effectiveness of anti-retraction handpieces, rubber dam isolation, HVE, and cold atmospheric plasma specifically in infection control of the current coronavirus strain, SARS-CoV-2.

Background: This article describes the development of an oral hygiene self-care behaviour change intervention (Safeguard Your Smile [SYS]) for Punjabi immigrant adults, using the Behaviour Change Wheel (BCW) theoretical framework. Methods: The 3 stages and 8 steps of the BCW were followed to develop the face-to-face SYS intervention. Identification of the problem in behavioural terms was enabled by referring to the results of a qualitative focus group (FG) previously conducted by the research team. Following the BCW method, the sources of behaviour were defined in terms of capability, opportunity, and motivation. Appropriate intervention functions, policy categories, behaviour change techniques (BCTs), and modes of delivery were then identified, selected, and mapped. Concrete strategies were chosen to bring about the desired oral hygiene self- care behavioural change. Results: Two main barriers to oral hygiene self-care faced by Punjabi immigrant adults were identified from the original FG: 1) inadequate knowledge and 2) inconsistent daily routine. Oral hygiene self-care behaviour was designated as a target behaviour, detailing frequency, duration, and technique. Five intervention functions (education, training, modelling, environmental restructuring, and enablement) and 2 policy categories (communication and service provision) were identified to influence the capability, opportunity, and motivation related to oral hygiene self-care behaviour. Nine BCTs were selected to influence desired oral hygiene self-care behaviour among adults. Conclusion: The development process for this SYS intervention may be employed by researchers to design a behaviour change intervention for other populations. However, additional strategies tailored to each specific context and population must be incorporated.

Aim: The aim of this position paper is to investigate the current state of the evidence for proposed associations between periodontitis and rheumatoid arthritis, Alzheimer’s disease, obesity, inflammatory cancers, and renal disease using a narrative review approach. This is the last of a series of 5 position papers from the Canadian Dental Hygienists Association (CDHA) on the relationship between periodontitis and systemic conditions. Methods: Individual literature searches were conducted for each of the 5 proposed linkages and limited to human studies, with a preference for systematic reviews (SRs) and prospective studies, in the English language, published between 2015 and 2021, focused on associations between 1) periodontitis and rheumatoid arthritis; 2) periodontitis and Alzheimer’s disease/cognitive impairment; 3) periodontitis and obesity; 4) periodontitis and inflammatory cancers; and 5) periodontitis and chronic kidney disease. Databases searched were PubMed, MEDLINE/OVID, CINAHL, Scopus, Cochrane Registry of Systematic Reviews, and Web of Science. Results: A total of 39 papers were selected for discussion, including 6 SRs for rheumatoid arthritis; 7 SRs for Alzheimer’s disease/cognitive impairment; 11 SRs, 1 meta-review of SRs, and 1 population-based cohort study for obesity; 9 SRs for inflammatory cancers; and 4 SRs for kidney disease. Conclusions: The evidence for the 5 proposed associations varied in strength, with obesity being most strongly associated with periodontal disease. More robust studies are recommended to clarify the exact nature of these associations.

In British Columbia, Canada, First Nations children and youth consistently present with a higher incidence of dental disease. Efforts to improve the oral health status of Indigenous populations have had mixed success, and programs have typically been offered through a Western lens. Recent years have brought calls for oral health professionals to embrace a more holistic approach to health promotion, representative of Indigenous cultures. Colonization has been considered a negative health determinant as it led to the destruction of culture, language, and the removal of Indigenous peoples from their traditional lands. Self-determination and cultural connection are critical to mitigating cultural genocide. Health promotion projects have the potential to support these goals. Fundamental to decolonizing oral health promotion is the development of a sustainable program founded in the traditional ways of Indigenous health and healing. The purpose of this short communication is to report on a collaborative oral health project that used cultural connection as the framework for oral health promotion in a remote Indigenous community.

Background: Burnout syndrome is the result of prolonged occupational stress. The syndrome has 3 dimensions: emotional exhaustion (EE), depersonalization (DP), and reduced personal accomplishment (PA). This study aimed to examine the prevalence of the 3 dimensions of burnout in dental hygienists in Nova Scotia, Canada, (N = 745) as they returned to work during the COVID-19 pandemic following a furlough; to explore the effect of burnout during COVID-19 on dental hygienists’ professional lives; and to determine the tools and methods that dental hygienists use to overcome burnout. Methods: In this cross-sectional study, participants were asked to complete an anonymous survey inclusive of demographic information, employment characteristics, the Maslach Burnout Inventory Human Services Survey for Medical Personnel (MBI-HSS [MP]), and 2 open-ended questions. Results: The response rate was 34.9% (n = 260). Approximately one-third (36.2%) of respondents met the criteria for burnout. Contributors to burnout were time, providing dental hygiene care, expectations of dentists, physical and mental health, lack of autonomy, and the COVID-19 pandemic. Reported mechanisms to overcome occupational stress centred on work–life balance, social support networks, working in a positive environment, and physical activity. Discussion: This study took place during the first wave of the COVID-19 pandemic, which may have influenced the rate of burnout among dental hygienists, particularly within the EE domain where scores were twice as high as those reported in pre-COVID-19 studies. Conclusion: Dental hygienists may be at risk for burnout. Recognizing the signs and symptoms of burnout and implementing healthy behaviours may reduce its detrimental effects.

Objective: To examine the effectiveness of peer-led preventive oral health education for elementary school-aged children. Methods: A controlled, nonrandomized interventional study included children in grades 4 to 6 (N = 372) from 6 schools in British Columbia, Canada. The control group (3 schools) received a class-based lecture on oral health. In the intervention group (3 schools), each sixth grader mentored a small group of fourth and fifth graders. The study outcomes were 1) need for oral care referrals (visual screening); 2) oral health knowledge (self-reports); 3) oral self-care practice (OSC-P); and 4) oral self-care skills (OSC-S). Assessments of OSC-P and OSC-S were based on disclosed dental biofilm levels. Study group comparisons were done at baseline and 8 to 12 months. Results: A high need for oral care referrals was found, with a substantial reduction achieved during the study period. Dietary knowledge improved minimally in the intervention group. In both study groups and within age groups, there was a wide variation in OSC-P and OSC-S. Overall, children’s OSC-P scores were substantially higher than their OSC-S scores. Oral self-care outcomes improved over time in both groups (except for fourth graders in the control group), with a more substantial improvement in the intervention group. From baseline to study end, the mean OSC-P improved by 11.9% (intervention group) and 5.9% (control group). Improvement values for OSC-S were 12.8% and 5.2%. Conclusions: The need for oral care referrals was reduced, but improvement in oral health knowledge was minimal. Oral self-care outcomes improved more in the intervention than in the control group.

Background: As more adults reach advanced age with natural teeth, there is an increasing need for dental and dental hygiene practices to provide care for older adults and individuals living with dementia. Little is known about how well these populations are accommodated in private practice. Methods: Following approval from the Research Ethics Board at Mount Allison University, a survey was sent to the 517 practising dental hygienists in New Brunswick, Canada. They were asked to rate on 5-point scales their geriatric oral care knowledge, their willingness to receive more education on the topic, and how frequently they adjusted their care provision to meet the needs of older (age 70+) clients and those living with dementia. Results: A total of 121 dental hygienists responded (23.4% response rate). Overall, respondents were willing to learn more about geriatric care, but lacked knowledge about the oral health effects of certain medications frequently used by older adults, and about techniques for accessing the oral cavity of clients with dementia. Many accommodations recommended by geriatric specialists were not consistently carried out. Discussion: Given that older adults and adults with dementia make up an increasingly large part of the population in need of oral care, geriatric and dementia oral care needs should be emphasized in dental and dental hygiene practices and continuing education for dental hygienists. Conclusion: More research is required on the impact of integrating accommodations for older clients and clients with dementia into clinical practice, as well as how oral care is experienced by these populations.

Background: Medical and dental schools have long-established pedagogical approaches to teacher-centred face-to-face learning. The 3-year baccalaureate dental hygiene (DH) program at the University of Alberta, which enrolls 42 students of diverse ages and experiences each year, is no exception. Oral Biology II (OBIOL 302) is an intermediate-level course in the DH program; it was moved to an asynchronous online format to manage the disruptions of the COVID-19 pandemic. This mixed-method study explores the factors affecting the dental hygiene student experience in this online, asynchronous learning environment. Methods: This study used a quantitative anonymous survey with a 5-point Likert scale to evaluate the workload and flexibility of the course as well as student acceptance of the assessments. The mean score and standard deviation were calculated for each question in the online survey. A research facilitator conducted interviews using a semi-structured interview guide to further explore student experiences. The qualitative data were then analyzed using a 6-step method of thematic analysis. Results: The study participants found the format and workload of the online course appropriate and well-suited to the spring term. Thematic analysis of the qualitative data revealed 3 intersecting elements—course structure, communication, and non-curricular aspects—as the key factors shaping student experiences in an online environment. Conclusion: This study identified the major factors affecting the online learning experience of students from the students’ point of view, which will be a useful guide to design more effective online courses for health science education.

Individuals experiencing homelessness face unique barriers to oral health care. In collaboration with local universities in Ottawa, Canada, research was conducted to explore the experiences of Community Veterinary Outreach (CVO) clients in accessing oral health care. CVO utilizes a One Health approach, providing preventive veterinary care alongside human health care services to promote health service uptake among pet owners experiencing homelessness. Based on the results of 4 research projects, this short communication proposes recommendations for promoting accessible oral health care and increasing service uptake at One Health clinics by CVO clients experiencing homelessness. Relevant themes leading to the recommendations were 1) barriers to care, including financial and individual circumstances, and discrimination by service providers; and 2) facilitators of care, including the presence of pets, compassionate care, and care received in community settings. Recommendations to improve accessibility of oral health services for CVO clients are 1) continuation of pet-friendly services; 2) delivery of oral health care in alternative settings; and 3) reduction of discrimination through continuing education for oral health professionals. It is hypothesized that the implementation of these recommendations will improve oral health care service accessibility and uptake among clients at CVO clinics and in the community.

Background: Interprofessional education (IPE) promotes team-based approaches to professional practice and lifelong collaboration. However, there is little consensus on its “best practice” in dentistry and dental hygiene curricula. This study aimed to explore dental hygiene students’ perceptions and experiences of collaboration with dentistry students in an IPE program that authentically represents private practice settings and work processes. The intent was to identify what students thought would best help prepare them to work collaboratively in an oral health team once they graduated after participating in this experience. Methods: Data were collected from 40 dental hygiene student written reflections and 6 dental hygiene students through a focus group session that was audiorecorded and transcribed. Data were examined using thematic analysis. Results: Five interrelated themes emerged: 1) understanding of roles and responsibilities; 2) hierarchical perceptions and level of experience; 3) team dynamics; 4) instructor and staff involvement and support; and 5) timing and structure of IPE activities. The findings suggest that dental hygiene students need consistent and sustained access to realistic environments in which to practise team roles and work directly with dentistry students. Opportunities to build relationships with dentistry students before working together in professional roles appear to alleviate hierarchical concerns that impede teamwork. Conclusion: IPE should occur throughout students’ education as hierarchical perceptions appear to influence collaboration. Informal and/or non-clinical IPE opportunities should be introduced early in students’ education to develop a foundation for team dynamics in later formal and/or clinical IPE activities. Students should collaborate in ways that will be reflected in professional expectations after graduation; the environment in which they learn their team role should provide the opportunity to authentically practice it.

Objective: This narrative review examines the literature on type 1 diabetes mellitus (T1DM) and periodontitis pathogenesis, seeking to determine the effectiveness of periodontal therapy in improving glycemic control in individuals with T1DM. Methods: A detailed search of the literature was conducted in the following electronic databases: PubMed, Google Scholar, Scopus, and Cochrane Library. Inclusion criteria were systematic reviews with meta-analyses published between 2015 and 2020, and human peer-reviewed clinical trials addressing the effectiveness of periodontal treatment on glycemic control in individuals with T1DM published between 1995 and 2020. Results: The search retrieved 3 systematic reviews and 9 original research papers that included 10 clinical studies. Discussion: Three systematic reviews on T1DM and periodontal disease suggested that individuals with T1DM have more features of periodontitis than healthy subjects, although long-term data are scarce. Nine of the ten clinical studies showed no impact on glycemic control in individuals with T1DM, while 1 study reported improvement. Conclusion: The selected literature lacked data on long term assessment and adequate randomization with controls. The data perused did not provide sufficient evidence to determine the effectiveness of periodontal therapy in improving glycemic control in type 1 diabetes or to suggest that T1DM is a risk factor for periodontal disease.

Objectives: Research shows that approximately 75% of people worldwide access the internet for health information. Lower calibre websites often use inaccurate claims to attract internet browsers. The objective of this review is to alert oral health care professionals (OHCPs) to the impact of oral health media hype on client perceptions of oral care. It also aims to provide OHCPs with tools to educate clients on how to identify credible oral health information online so that they can make informed oral health treatment decisions. Methods: A literature search was conducted using PubMed and Google Scholar. The returns were screened using inclusion and exclusion criteria. Results: Thirteen studies met the inclusion criteria, of which 12 (92%) identified that clients browse the internet to research oral health conditions and treatments. Eleven studies (85%) concluded that media outlets influence client perceptions of oral health care and treatment. All 13 studies (100%) found that OHCPs and organizations should better guide clients with tools to discern between evidence-based (EB) and non-evidence-based (NEB) online health information. Discussion: According to the literature, viewing NEB oral health information on the internet affects clients’ perceptions of oral health care, which may lead to potentially harmful treatment decisions. Chairside education is effective in reducing the impact of oral health misinformation. Conclusion: OHCPs have the responsibility to address the impact of media hype on clients’ perception of oral health care and to direct them to credible health information.

Traumatic ulcerative granuloma with stromal eosinophilia (TUGSE) is a rare, benign, and self-limiting ulcerative lesion, with the tongue being the most common site of occurrence and traumatic inflictions being the common etiology. Case report: A 45-year-old female reported to the dental operatory with a complaint of pain on the left side of her tongue for the past 8 months. Her history revealed that a small ulcer had gradually grown to be 2 cm x 1.5 cm on presentation. She indicated that the ulcer often interfered with her maxillary left canine while occluding. She also gave a history of a tobacco chewing habit for 15 years which she stopped 6 years ago. Clinically she had a single erythematous ulcer with irregular borders and raised margins. The client was treated with surgical excision of the lesion. The excised lesion was confirmed histologically to have eosinophil rich cells and was diagnosed as TUGSE. Conclusion: TUGSE should be recognized and not neglected as it closely resembles malignancies of the oral cavity. It also has a good prognosis and heals rapidly after the surgical excision or on its own with time, which may range from a few weeks to a year.

Periodontal disease is associated with diabetes mellitus and poor overall health. While the biological underpinnings of this relationship have been identified, less is known about the extent to which this relationship is affected by dental and medical care visits. Two studies lead by the primary author (KKP) explored the likelihood of diabetes complications among persons living with diabetes in Ontario, Canada, who were followed prospectively in administrative health data. The results from both studies confirmed that poor to fair self-reported oral health was associated with a greater risk for diabetes complications, and that poor dental and medical care visiting behaviours increased this risk. In general, the findings indicate that a greater number of dental and medical visits had a protective effect on the overall health of persons with diabetes. This discovery has important implications for all health care providers interested in managing oral and systemic health.

Background: In 2017, the American Academy of Periodontology and the European Federation of Periodontology updated the classification of periodontal and periimplant diseases and conditions. The goal of the present crossover study was to develop straightforward, illustrative flowcharts and determine their impact on the accuracy and speed of diagnosing periodontal conditions by predoctoral dental students (DS) and dental hygiene students (DHS). Methods: Two flowcharts (a decision-tree flowchart and one based on the periodontal disease/condition entity) were developed using updated diagnostic determinants proposed by the 2017 classification. A total of 26 second-, third-, and fourth-year DS (DS2, DS3, and DS4, respectively) and second-year DHS (DHS2) took a mock examination consisting of 10 periodontal clinical cases. The participants first diagnosed periodontal conditions using only their curricula-based knowledge (control) and then using the flowcharts (test). They also completed an optional post-examination questionnaire to provide feedback on the flowcharts. Statistical significance was detected at p = 0.05. Results: Combined test groups had significantly higher accuracy in diagnosing periodontal conditions compared to controls (73.5% vs 50.0%, respectively), with the most substantial improvement in DS2 (66.3% vs 30%, respectively) and DHS2 (70.0% vs 41.4%, respectively). Combined test groups also completed the examination more quickly compared to controls (14.92 vs 20.85 minutes, respectively). The participants provided positive feedback and constructive criticism on the flowcharts, and also suggested converting them into application software. Conclusion: The flowcharts significantly improved the accuracy of diagnosing periodontal conditions in academic settings, especially among junior, less experienced participants.

Dental caries is still one of the most prevalent diseases worldwide. Research has shown that fluoride has a role in caries prevention. For many reasons there are concerns about young children using fluoride-containing oral care products. Consequently, there is a need to identify effective fluoride-free products. A large body of literature now exists on the use of biomimetic hydroxyapatite (HAP) as an active ingredient in oral care products to combat caries. Aim: To conduct a systematic review of the clinical evidence of the effects of HAP-based fluoridefree oral care products in caries reduction and conduct a meta-analysis of available randomized clinical trials (RCTs). Methods: Using the PICO question “In individuals of all ages (P), do fluoride-free oral care products containing HAP as the anti-caries agent (I), compared to products with fluoride or without caries control products (C), reduce the risk of dental caries (O)?” Ovid MEDLINE (PubMed), Scopus, EMBASE, and Web of Science databases were searched using the following keywords: apatite, hydroxyapatite, caries, dental decay, dentin(e), enamel, toothpaste, dentifrice, mouthwash, gels, biofilm, (dental) plaque, ero(de, ded, sion), (de, re)mineral(ise, ized, ised, ization, isation). Reviews, tooth whitening, tooth sensitivity, and in vitro studies were excluded. PRISMA was used for the search and GRADE was used to assess quality. Clinical trials were subjected to the Cochrane Risk of Bias assessment followed by meta-analysis. Results: 291 studies were retrieved; 22 were suitable for systematic review, 5 were clinical caries trials and 4 were RCTs. A meta-analysis of 3 RCTs was possible showing HAP provided 17% protection against caries. The other 17 trials had simpler proxy outcomes for anticaries effects. Some trials showed non-inferior performance of HAP products compared to those with fluoride. Conclusion: There is good evidence that hydroxyapatite in oral care products in the absence of fluoride effectively reduces caries.

Background: Autism spectrum disorder (ASD) is a developmental disorder that affects behaviour and communication skills. ASD is estimated to affect approximately 1 in 66 Canadians, with symptoms typically arising within the first 3 years of life. Individuals with ASD present with an increased burden of disease and face heightened barriers to oral care. Objective: This narrative literature review aims to raise awareness of the additional needs that individuals with ASD have when seeking oral care and to identify how barriers to such care may be reduced. Methods: Twenty-one articles were included in this review, with a wide range of study designs and methodologies. Search terms in PubMed, Education Source, and CINAHL databases included autism spectrum disorder, barriers, dental, dental hygiene, developmental disability, oral health, and unmet needs. Results and discussion: Key themes that emerged as barriers to care were behavioural challenges, inhibited social and communication skills, parental dependence, clinic environment, and abilities of oral health professionals to treat clients with special care needs. Conclusion: Current literature reveals that individuals with ASD face numerous barriers when accessing oral care and attempting to achieve adequate oral health, thus contributing to an increased burden of disease. Oral health professionals should aim to improve their understanding of special care populations such as the ASD community and raise awareness among health care professionals to work towards diminishing the barriers to care these populations experience.

Background: Research has revealed that periodontal diseases are caused by inflammation that results from a dysbiosis of the oral microbiome where oral bacteria multiply into larger communities referred to as dental biofilm. To help control this overgrowth of bacteria, a variety of toothpastes, dentifrices, and mouthwashes have been developed. Although not as common in North American toothpastes, propolis as an active ingredient in dentifrices has begun to emerge, as laboratory studies have suggested it has anti-inflammatory, immunomodulatory, antioxidant, antimicrobial, and antidiabetic properties. The purpose of this scoping review was to explore the literature on the effectiveness of propolis in maintaining oral health. Methods: This review used the following criteria: Population: studies involving healthy humans; Intervention: propolis in the form of toothpaste, dentifrice, and mouthwash; Comparison: fluoride, chlorohexidine, and placebo; Outcomes: plaque and gingival indices, improvement in oral hygiene, and inhibition of bacteria. Relevant research articles were selected from Web of Science, PubMed, MEDLINE, and Scopus databases using the search parameter “propolis[tw] AND (toothpaste*[tw] OR dentifrice*[tw] OR mouthwash*[tw])”. Only original articles published after 2009 and written in the English language were included. Results: A total of 19 original papers met the criteria and showed varying levels of success achieved with the use of propolis. It was responsible for a significant lowering of specific plaque and gingival indices, inhibited the growth of bacteria, reduced oral flora diversity, and consistently improved periodontal condition, oral hygiene, and oral health. Conclusion: Propolis may play a role in initiating, sustaining, and maintaining oral health as its desirable properties have the potential to improve various oral hygiene related indices.

Dentigerous cysts are one of the most common developmental types of odontogenic cysts occurring in the oral cavity and often manifest as incidental findings on dental radiographs and/or as asymptomatic swellings. These cysts develop from remnants of reduced enamel epithelium around the crown of an unerupted or impacted tooth, attached at the level of the cementoenamel junction. Most are considered developmental. However, in young clients they may be inflammatory in origin, the result of caries in the primary dentition. This short communication highlights a case of an asymptomatic dentigerous cyst identified in a 4-year-old child and subsequent enucleation under general anesthesia. A thorough clinical and radiographic assessment of the oral cavity in pediatric clients merits a review of dentigerous cysts by the dental hygienist.

Objective: Due to the widespread availability of online information, oral care providers are no longer the main source of oral health information for clients. This shift in the balance of knowledge has the potential to alter clients’ experiences and relationships with their oral care providers, including dental hygienists. This review explores how access to online health information has influenced clients’ experiences with their dental hygienists. Method: A narrative literature review of quantitative, qualitative, and mixed-method studies concerning clients’ experiences with online health information and how it has influenced the client–health care professional relationship was completed. The electronic databases searched were Google ScholarTM, PubMed, and CINAHL. Twenty-three studies published between 2005 and 2020 were included. Results and discussion: The majority of clients used the internet to access health information to be better informed about health issues. Both clients and health care providers had concerns about the legitimacy and accuracy of various online information sources. Clients faced various communication facilitators and barriers when discussing this information with their health care provider. A positive response by the health care provider led to an improved client–clinician relationship, whereas a negative response led to distrust among all parties. Clients would be open to e-health literacy training by their dental hygienists. Conclusion: Clients’ access to online health information can either improve or worsen their experiences and relationships with their dental hygienists, depending on the response by the dental hygienist when these topics are broached. Dental hygienists should consider taking time to provide e-health literacy training to clients during consultations.

Objective(s): The need for interprofessional education (IPE) has been well documented and communicated by many prominent government bodies and health organizations. However, more longitudinal outcomes research is needed to demonstrate the impact of IPE on students’ attitudes and behaviours. This study assessed dental hygiene students’ readiness for IPE and collaborative practice at the University of British Columbia. Methods: Ethics approval was granted by the university’s behavioural research ethics board (H18-02026). This study employed a mixed-methods approach. A modified Readiness for Interprofessional Learning Scale (RIPLS) survey was completed by 23 (96% response rate) second-year dental hygiene students prior to commencing the university’s newly integrated 4-week IPE curriculum and immediately following its completion approximately 1 month later. A focus group comprising 5 students then explored learning experiences and impact on attitudes towards collaborative practice in greater depth. Curriculum content included professionalism, ethical practice, Indigenous cultural safety, and resiliency. Results: Attitudinal shifts were observed in 3 of the RIPLS measures, suggesting that students found greater clarity regarding their professional roles and became more receptive to learning clinical problem-solving skills with other disciplines. No statistically significant differences were found between the pre-attitudinal and postattitudinal RIPLS measures. The focus group revealed 3 prominent themes: greater role clarification, recognition of similarities in knowledge and practice of other professions, and cultivation of professional identity, collegiality, and respect. Conclusions: Dental hygiene students gained greater clarity about professional roles and developed an enhanced appreciation for working with other health professions after completing the university’s month-long integrated IPE curriculum.

Objective(s): To examine the confidence levels of fourth-year baccalaureate students in their ability to demonstrate the Canadian Competencies for Baccalaureate Dental Hygiene Programs (CCBDHP), first published in 2015 by the Canadian Dental Hygienists Association (CDHA). This document is the first articulation of dental hygiene baccalaureate competencies in North America. However, there is little evidence to support that baccalaureate graduates are acquiring these abilities. Methods: This 3-year longitudinal study rated the self-confidence levels of fourth-year students as they neared graduation from the University of British Columbia from 2017 to 2019. It involved an online, anonymous survey using a 5-point scale ranging from not confident to confident. Respondents rated their self-confidence in the 110 subcompetencies articulated within the 13 competency domains of the CCBDHP. Results: Responses were received from 54 of the 70 graduating students for a cumulative 77% response rate. Respondents expressed the most confidence in the competency domains of clinical therapy (100%), collaboration (100%), disease prevention (100%), professionalism (100%), and oral health education (90%) but expressed less confidence in research use (73%), health promotion (70%), leadership (67%), policy use (20%), and advocacy (11%). Conclusions: These data suggest that curriculum revisions are needed in 5 domains but such changes may not be sufficient. Transition support may be warranted to assist graduates as they enter practice, while some competencies may be more appropriate for graduate studies. The study contributes to an international discussion about the educational preparedness of baccalaureate graduates and the boundaries between diploma, baccalaureate, and master’s level education.

Objective(s): Transgender individuals face barriers to health care such as harassment, violence, and refusal of care. Current literature shows a lack of instruction on caring for sexual minority clients in dental and allied dental education programs, which contributes to the barriers to care encountered by this population. The purpose of this quasi-experimental study was to determine the effectiveness of an educational workshop on dental hygiene student competence and comfort levels in treating transgender clients. Methods: Dental hygiene students’ competence and comfort levels in treating transgender individuals were evaluated using an adapted version of the Assessing Medical Attitudes Toward Transgender Care survey. A panel of experts established content validity of the adapted survey. Primary data were collected online from a convenience sample of dental hygiene students (n = 45) who attended an educational workshop about caring for transgender individuals. Data were collected at week 1 (baseline) and week 6 (post-workshop). Ethics approval was obtained from AT Still University and Texas Woman’s University. Results: The Wilcoxon signed-rank test was used to analyse the data. The results showed a statistically significant increase from pre-test to post-test in competence (1.6667–3.0000; z = 5.373) and comfort (3.0000–3.8000; z = 4.799) scores after attending the educational workshop, p < 0.001. There was a statistically significant increase from pretest to post-test in the score for all competence and comfort questions. Conclusions: The findings of this study suggest that education on transgender health care increases competence and comfort levels among dental hygiene students and should, therefore, be included in dental and allied dental education curricula. When creating and revising dental hygiene curricula, educators and policymakers should ensure this content is included in sufficient scope and depth to prepare graduates to care for this population.

Objective(s): For the progression of the dental hygiene profession, a need exists for researchers who focus on creating theoretical concepts and disseminating evidence specific to dental hygiene. Engaging undergraduate dental hygiene students in research experiences may foster interest in and overcome barriers to graduate education and may improve the implementation of evidence-based practice. The purpose of this study was to explore the relationships between original research experiences and evidence-based practice among undergraduate dental hygiene students. Methods: Following ethics approval (TUI 1209), this study utilized a mixed-methods research design involving a quantitative survey and qualitative case study. The target population was undergraduate dental hygiene students in the last year of their entry-level dental hygiene programs. The Wessex Research Network (WREN) spider instrument measured original research experience and the KACE instrument measured evidence-based knowledge, attitudes, access, and confidence in implementing evidence-based practice. Survey invitations and 2 email reminders were sent to program directors of US dental hygiene programs to forward to dental hygiene students in their final year. Semistructured interviews and focus groups were conducted with participants who had original research experiences. The data were analysed using descriptive statistics, bivariate analysis, linear regression, and thematic analysis. Results: The responses from 128 participants were analysed. The level of research experience was M = 27.63 (SD = 7.88) and the level of evidence-based practice was M = 92.80 (SD = 15.04). Research experience was significantly correlated with evidence-based attitudes, access, and confidence (p < 0.01). Research experience was found to be a significant predictor of evidence-based practice (p < 0.001). Thematic analysis revealed how research experiences affected evidence-based practice through knowledge, attitudes, access, and confidence. Conclusions: The extent of research experiences impacted the level of evidence-based practice among undergraduate dental hygiene students. Incorporating original research experiences into the dental hygiene curriculum may improve the implementation of evidence-based practice.

Objective(s): Improving oral health for priority populations, those most at-risk for oral diseases, may be accomplished by integrating basic oral health care into primary health care, including health, school, and community-based social services. Seven entrustable professional activities (EPAs) have been identified that facilitate the integration of oral health assessment and management into primary health care. The purpose of this study was to identify which Canadian health care provider (HCP) groups may be entrusted with professional oral health activities. An additional aim was to explore the degree to which the scopes of practice of the entrustable health professionals align with the 7 EPAs. Methods: Three criteria were used to identify entrustable health professionals whose practice aligns with the EPAs: 1) HCP groups were identified using the Canadian Institute for Health Information Workforce Database; 2) oral health professionals and professionals with no direct patient contact were excluded; 3) national competency profiles of included HCP groups were analysed by 3 independent reviewers to identify whether specific competencies encompassed one or more of the EPAs. Discrepancies among reviewers were resolved through discussion to consensus. Once identified, applicability of EPA competencies to the competency profile was confirmed by a consultant with expert knowledge of the scope of practice of each HCP group. Results: Thirty HCP groups were identified. Three oral health provider groups, three HCP groups without patient contact, and three without a national competency profile were excluded. Findings suggest that 20 of 21 identified HCP competency profiles align with one or more EPAs, most notably, oral health assessment, education and treatment, and referral to an oral health professional. Conclusions: Several HCP groups may be able to incorporate one or more of the EPAs into their practice. Future research should explore the current oral health-related knowledge, attitudes, and practice patterns of the identified HCP groups.

Objective(s): A positive correlation has been reported between periodontal treatment time and serum C-reactive protein (CRP) levels 24 hours after treatment. This study sought to investigate the immediate systemic inflammatory response following full-mouth debridement within a 24-hour period, and to determine any differentiation between use of hand compared with ultrasonic instruments. Secondary outcomes were aimed at evaluation of clinical parameters and time taken for treatment. Methods: Thirty-nine periodontitis clients were randomized to treatment with full-mouth debridement using either hand instruments alone or ultrasonic treatment alone, completed within 24 hours. Serum and periodontal clinical parameters were collected at baseline, day 1, day 7, and day 90 posttreatment. Differences in systemic inflammatory markers were assessed using general linear models at each timepoint, corrected for age, gender, smoking status, body mass index, and baseline levels of each marker. Results: Across all clients, serum CRP increased at day 1, with no differences between hand and ultrasonic groups (p[adjusted] = 0.22). There was no difference between groups in interleukin-6 (p[adjusted] = 0.29) or tumor necrosis factor ?? (p[adjusted] = 0.53) at day 1. Inflammatory markers returned to baseline levels by day 7. Treatment resulted in equal and marked improvements in clinical parameters in both groups. However, total treatment time was on average shorter for ultrasonic instruments (p[adjusted] = 0.002). Conclusions: Treatment time for hand instrumentation correlated positively with disease severity, while ultrasonic treatment time was stable regardless of disease levels. Ultrasonic treatment was overall shorter and resulted in comparable clinical outcomes. Levels of serum CRP at day 1 were similar following debridement with hand or ultrasonic instruments.

Objective(s): Oral lichen planus is a mucosal lesion often encountered by oral health professionals. Microscopically, these lesions present with a band of immune cell infiltrate at the epithelial–connective tissue junction. This heavy inflammation may induce reactive changes in the epithelium resembling dysplasia, casting uncertainty on the true malignant potential of lichenoid lesions with dysplasia (LLD). Some theorize that there are subtypes with primary lichenoid and secondary dysplastic features (L1D2), or primary dysplastic and secondary lichenoid features (D1L2) that have differing malignant risks. This study aimed to analyse whether these subgroups exist and to compare the proportion of malignant progression in these groups. Methods: Ethics certification was obtained from the University of British Columbia Research Ethics Board (REB #H19-01785). Clinical and outcome data (defined as progression to severe dysplasia, carcinoma in situ, or squamous cell carcinoma) and formalin-fixed paraffinembedded tissue sections were collected from patients with a diagnosis of low-grade LLD, no history of head and neck cancer, and at least 5 years of follow-up. Using a casecontrol design, 11 cases and 33 controls were required to detect a significant difference with 5% significance and 80% power on 2-tailed tests. Basement membrane (BM) degeneration was analysed using immunohistochemistry to detect collagen IV; normal tissue was used as a positive control. Inferential statistical analysis was performed using logistic regression. Results: BM degeneration was seen in both the cases (n = 10) (70%) and controls (n = 32) (78%), with no statistically significant difference between groups (p = 0.69). Conclusions: The results of this pilot study suggest that the proposed subtypes of LLD with the absence or presence of basal cell/BM degeneration do not have differing malignant risks. Rather, any dysplasia in lichenoid lesions is indicative of malignant potential and should be monitored clinically.

Objective(s): Health is created in settings where people live, work, learn, and play. Inherent to healthy learning are structures, policies, and strategies that enable health. Still, evidence mounts that the dental hygiene (DH) and dental (DMD) learning environments and curricula challenge student health; further, that program focus remains treatment- and prevention-oriented. This study explored DH and DMD students’ sense of coherence (SOC) and perceptions of their programs from a salutogenic, healthylearning perspective. A moderate SOC signifies a healthoriented or salutogenic life disposition. Healthy learning positions students to be workforce health-promoting agents. Methods: Sequential exploratory mixed methodology guided the study. First, 40% and 33% of the DH and DMD senior students, respectively, at a single institution participated in focus groups. Thematic analysis followed; the themes informed the Health-Promoting Attributes survey’s content (Cronbach’s alpha > 0.70). Then, 79.5% of the students with 1 year of program experience completed the survey, including the Sense of Coherence-29 (SOC-29) questionnaire, a validated salutogenic measure. Survey data analysis involved inferential statistics. The study received ethics approval (HS 21378; H2017:421). Results: Seven themes emerged from the focus groups: realizing health-of-self; sensing program as health-promoting learning setting; experiencing health-of-self curriculum; programming structure; programming strategy; healthpromoting people; and facilitating learning environment. The DMD program predicted realizing health-of-self and program structure. The DH program predicted health-ofself curriculum, program strategy, and health-promoting program-based people. Students perceived a lack of and limited environmental support for a health-of-self curriculum. The SOC-29 scores indicated a moderate SOC for both student groups with a small effect (r = –0.25, p = 0.004) seen between programs (DMD: M = 127.37 SD = 19.08; DH: M = 116.60 SD = 17.19). Conclusions: Students possess a moderate SOC enabling them to navigate healthchallenging programs. However, DH and DMD programs need to become healthy-learning settings so graduates can enter practice as healthy workplace advocates.

Objective(s): The aim of this study was to describe dental hygienists’ experiences related to healthy and respectful workplaces. Specifically, it sought to 1) understand the scope of issues related to healthy and respectful workplaces; 2) determine the prevalence of harassment, bullying, abusive and violent behaviours in the workplace; and 3) explore the factors associated with these behaviours. Methods: An online self-administered survey was sent to all members of the Canadian Dental Hygienists Association. Respondents were asked to report the occurrence and frequency of mistreatment experienced over their career as a dental hygienist and any negative impacts experienced as a result of mistreatment. Descriptive univariate and bivariate statistics were performed on SPSS. Results: Responses were received from 3,780 dental hygienists (response rate = 22%). More than 70% of respondents experienced some form of mistreatment over their career, from dentists, office managers, coworkers or clients. Older, more experienced dental hygienists with higher levels of education and without policies in their workplace to address these issues had significantly higher odds of experiencing an incident of mistreatment. Of those who experienced mistreatment, 67% reported losing the respect they felt for the offending person, 55% reported experiencing symptoms of depression, and 30% quit their job. Conclusions: Mistreatment of dental hygienists appears to be prevalent in Canadian dental care settings resulting in negative consequences for mental and financial well-being.

Objective(s): The University of British Columbia’s dental hygiene degree-completion (DC) program has offered an academic pathway for dental hygienists to earn a degree exclusively through an online delivery format since 2006. The students’ experiences transitioning to online learning and related student support needs have not been previously studied. Thus, this study investigated students’ experiences as they entered an online dental hygiene DC program. Methods: An online survey with open- and closed-ended questions was distributed to all 53 enrolled dental hygiene DC students in September 2019. Survey questions asked for demographic information, academic transitional experiences, social integration, and sense of belonging in the faculty and university, perceived barriers and challenges, and suggestions for future students. Results: Thirty-two students completed the survey for a 60% response rate. Most student respondents (78%) had no prior experience with online education. Only 59% of respondents were confident in their abilities to navigate a web-based learning environment. Three-quarters (75%) of respondents felt like a valued member of the Faculty of Dentistry community but only 47% felt they belonged to the larger university community. Most (72%) were familiar with the support resources within the faculty but fewer than half (41%) were aware of additional resources outside of the faculty. Students aged 30 years and older felt more comfortable reaching out to faculty and staff members (90% versus 55%; p = 0.05). Students with prior online learning experience were more aware of student support resources outside of the faculty (57% versus 36%; p = 0.05). Conclusions: Lessons learned from this study have informed several recommendations to better support student transition to online learning that can be applicable to this program and in other institutions.

Objective(s): The objective of the study was to compare student perceived outcomes of 2 dental hygiene cohorts following differing ultrasonic instrumentation (USI) curricula. Methods: A 2-group observational comparison study was conducted with a senior class following a “traditional” USI curriculum and a junior class following a “contemporary” USI curriculum. The junior class USI curriculum was introduced earlier in their programming, with more and different inserts and with a greater philosophical emphasis on USI. Students’ use, confidence, and preparedness in USI were measured through online questionnaires at 2 times. Ethical approval was received from the Multi-College Ethics Review Process from the host institution. Quantitative analysis calculated proportions, means, and t-tests comparing groups; significance was set at 0.05. Results: The response rate ranged from 21.5% to 52.9%. There were no significant differences between the 2 groups in the time students used ultrasonic versus hand instruments; students used ultrasonics approximately 60% of debridement time throughout programming. Regarding specific aspects of USI, earlier in their programming, the junior group was significantly more prepared with water control and fulcruming and had greater preparedness with curved inserts than the senior class. Initially, the senior students had statistically significant greater confidence levels than junior students. Towards the end of the program, the junior class had higher confidence than the seniors, but this finding was not statistically significant. However, the junior cohort confidence levels significantly increased from Time 1 to Time 2. Conclusions: Although all students demonstrated a similar level of use of USI, students following a “contemporary” ultrasonic curriculum were shown to have higher levels of preparedness with some aspects of USI and with curved inserts, and were found to have improving levels of confidence by the end of dental hygiene programming. The study reveals the need for ongoing evaluation to determine how best to implement USI curriculum.

Objective(s): Human papillomavirus (HPV)-related oropharyngeal cancers (OPC) have increased significantly despite the availability of the HPV vaccine. HPV-positive oropharyngeal cancer (OPC) is becoming more prevalent than tobacco-related OPC. Dental health care professionals (DHPs) screen for OPC and known risk factors, but many are not prepared to address immunization. The purpose of this study was to prepare DHPs and students to deliver effective prevention and immunization education against HPV-related OPC. An online training module was created to accomplish 3 specific aims: 1) increase DHPs knowledge of HPV infection; 2) increase DHPs confidence in their ability to provide effective HPV immunization counselling; and 3) improve DHPs attitude towards recommending HPV immunization to their clients during dental encounters. Methods: This study was declared exempt from ethical approval. Thirty-seven dental hygiene students completed a pre-test survey and then viewed an interactive online training module in HPV-related OPC and immunization counselling. Students completed a post-test survey one week later. Knowledge, confidence, and attitudes towards HPV prevention and immunization counselling, pre-test and post-test, were compared. Results: Respondents showed a significant increase (CI = 0.5, p = 0.00) in knowledge of HPV prevention, with mean scores ranging from 8.75 to 13.32 based on a 15-point scale. Respondents showed an increase (p < 0.05) in confidence and comfort in providing HPV immunization counselling. Similarly, there was an increase (p < 0.05) in positive attitudes towards recommending HPV immunization. Conclusions: Dental health care professionals’ role in disease prevention should include immunization counselling. Effective education and preparation for HPV counselling can be accomplished through specific modularbased education. This type of education would be beneficial in an institutional or professional setting. Texas A&M College of Dentistry Educational Research Grant provided funding for this project.

Objective(s): Epithelial-mesenchymal transition (EMT), a biological process characterized by a decrease in epithelial features and increase in mesenchymal traits, has been proposed as a critical mechanism in cancer development. The loss of E-cadherin, a cell-surface protein involved in epithelial cell–cell adhesion, is a hallmark feature of EMT. A potential mechanism in which E-cadherin contributes to malignant progression is via beta-catenin signaling through the Wnt pathway. E-cadherin and beta-catenin expression is altered from normal oral mucosa, oral epithelial dysplasia (OED), to oral squamous cell carcinoma (OSCC), but there is no longitudinal research on the role of these biomarkers in malignant progression. The objective of this study was to explore the expression of E-cadherin and beta-catenin in OED that progressed to oral cancer and to determine if these expression patterns predict malignant progression. Methods: 74 non-progressors and 37 progressors were included in this matched casecontrol study. Patient samples with a baseline biopsy of low-grade (mild or moderate) OED were obtained from the Oral Cancer Prediction Longitudinal Study. Samples that progressed to severe OED, carcinoma in situ or OSCC were progressors, and samples that did not progress were nonprogressors. Immunohistochemistry performed on fixed paraffin-embedded tissue samples to visualize expression patterns of E-cadherin and beta-catenin is ongoing. Logistic regression will predict progression. Results: There was no significant difference in age, sex, ethnicity, smoking history, and lesion size, appearance, colour, risk site, and grade of dysplasia between non-progressors and progressors. We hypothesized reduced epithelial E-cadherin expression and reduced membranous and increased cytoplasmic and/or nuclear beta-catenin expression in progressors compared to non-progressors, and that OED with this expression pattern would show greater likelihood of progression. Conclusions: This research enhances the understanding of EMT’s role in malignant progression and potentially aids in the prevention and early identification of oral lesions at risk of progression to cancer.

Objective(s): Canada has seen a growing movement towards the development of new pathways to further dental hygienists’ education, in order to strengthen cognitive and practice outcomes. According to the 2019 Canadian Dental Hygienists Association (CDHA) Job Market and Employment Survey, only 18% of respondents held a bachelor’s degree. This study investigated barriers to pursuing further education among Canadian dental hygienists who practise with a diploma as their highest educational credential. Methods: Purposeful maximum variation sampling was used to select Canadian dental hygienists across 10 provinces and 1 territory for 3 focus groups (n = 17) conducted through videoconferencing. Selected participants were CDHA members who practise with a dental hygiene diploma as their highest educational credential. The e-focus group discussions were transcribed verbatim and underwent thematic analysis for barriers to pursuing further education using Saldaña’s approach to descriptive and in-vivo coding. Member-checking was completed in 2 phases: transcripts were provided to participants, followed by thematic summaries to confirm emerging themes. Ethics approval was granted by the University of British Columbia’s Behavioural Research Ethics Board (H20-00455). Results: Barriers included family obligations, accessibility, perceptions of eligibility, lack of employer support, and financial restrictions. Other prevalent themes were awareness of programs offered and the benefits of completing a degree. A few participants also raised concerns around the stress and anxiety of being in school. Conclusions: These focus group findings were used to supplement answer options for a national online survey that has been distributed to all CDHA members. Survey results will then inform CDHA, provincial associations, and educational institutions of barriers to pursuing further education, strategies to reduce those barriers, and facilitate the furthering of degree education for Canadian dental hygienists.

Objective(s): The impact of high-stakes clinical summative assessments on student learning, well-being, achievement, and self-efficacy has been well documented. The literature has highlighted that multisource feedback and continuous, low-stakes assessments provide a more comprehensive and accurate representation of students’ developing clinical competence. The study’s purpose was to conduct a clinical program evaluation, as part of an internal quality assurance process, to explore student and faculty perspectives and experiences of high-stakes summative clinical assessments and the transition towards multisource, low-stakes, online daily assessments in the dental hygiene degree program (DHDP) at the University of British Columbia (UBC). Methods: The project received exemption from the institution’s behavioural research ethics board. Two independent focus group discussions were conducted on a purposeful sample of graduating dental hygiene students (n = 8) and clinical instructors (n = 4). The discussions were audiorecorded, transcribed verbatim, and Saldaña’s framework of descriptive and in vivo coding was utilized for analysis and thematic development. Two rounds of member-checking were also conducted to increase trustworthiness of the findings. Results: Student and instructor participants favoured the provision of multisource feedback and continuous, online, lower-stakes assessments indicating that it more accurately represented students’ developing clinical competence, while one-time, high-stakes assessments were more often influenced by a multitude of variables including stress, interexaminer differences, and failure to fail. Conclusions: Results from this research provided valuable insight into student and faculty experiences and perspectives of a high-stakes assessment environment and a subsequent multisource, lower-stakes assessment approach for the appraisal of clinical competency. Findings further strengthen understanding of assessment approaches for the evaluation of clinical competence and will inform curricular design and future assessment methodologies in the DHDP at UBC.

Background/Goal(s): The University of Manitoba established a pilot project that placed nurse practitioner, dental hygiene, and dental students in a learning environment together. The goal of the interprofessional initiative was to create an innovative and experiential learning opportunity for the students to enhance their understanding of oral–systemic health and bridge the oral health care setting with primary care. Objective(s): The aim of the study was to explore patient and nurse practitioner, dental hygiene, and dental students’ perceptions of an interprofessional education (IPE) initiative on oral and systemic health. It was important to know if students learned from the collaborative experience and if patients perceived improved care. Approach: Senior nurse practitioner, dental hygiene, and dental students participated first in online, face-to-face, and simulation learning experiences. Then in the College Dental Clinic, they worked in small interprofessional teams to assess patients’ oral and overall health and create interprofessional care plans with referrals to primary care. Students and patients completed surveys after each session, and patients were contacted for follow-up and referral. Descriptive statistics were used to analyse data. The University of Manitoba Human Ethics Research Board approved the project. Evaluation: Though the COVID-19 pandemic interrupted the study, preliminary data analysis reveals the majority of students perceived the interprofessional collaborative practice experience as beneficial. The follow-up process with patients was greatly impacted by the pandemic. In process is the complete analysis of the student and patient data. The feedback supports the time and effort needed to deliver an oral–systemic clinical experience that brings together students as they prepare to enter practice. The experience fosters a spirit of interprofessional collaboration to improve client care and outcomes.

Background: Periodontal disease continues to be prevalent globally, but little clinical research has been undertaken to evaluate the long-term benefits of a daily oral hygiene regimen on progression of gingivitis/early periodontitis. The objective of this study was to evaluate the effects of an oral hygiene regimen (OHR) on the periodontal health of adults in good general health with established gingivitis and early periodontitis over 24 months. Methods: A randomized controlled trial was conducted in adults with established gingivitis, with isolated sites of probing pocket depth >4 mm. Study participants were randomized to the OHR (bioavailable stannous fluoride dentifrice, oscillating-rotating electric toothbrush, cetylpyridinium chloride rinse, and floss; P&G) or usual care products (sodium fluoride dentifrice and manual toothbrush; P&G) groups. At baseline and every 6 months, gingivitis and periodontal measures were assessed and a prophylaxis was conducted. The primary outcome was Gingival Bleeding Index–Bleeding Sites (GBI–BS). Analyses used ANCOVA at 5% significance levels. Results: A total of 107 individuals were enrolled; 87 completed the study. Mean GBI–BS, Modified Gingival Index, and Probing Pocket Depth (PPD) scores were significantly lower at each visit for the OHR versus usual care group by 28% to 39%, 12% to 18%, and 6% to 13%, respectively (p = 0.0009). The magnitude of reduction in median number of =2 mm PPD loss events for OHR versus the usual care group at 24 months was 74%. Conclusion: Long-term use of the OHR produced significant periodontal health improvements versus the usual care products.

Objective: The purpose of this project was to understand the variation in admission criteria to Canadian dental hygiene programs and determine whether the criteria are appropriate in predicting a program’s success rate on the National Dental Hygiene Certification Exam (NDHCE). Methods: Admission criteria were gathered from the websites of English-language dental hygiene programs in Canada. Individual dental hygiene programs were also contacted directly by phone or email if their admission criteria were not outlined on the program website. NDHCE success rates for each program were collected from the National Dental Hygiene Certification Board website. The association between the admission criteria and NDHCE success rates was examined. Pearson’s product moment correlations were performed for post-secondary credits required for admission and program length. Results: Admission criteria for 29 of 30 dental hygiene programs were examined. Twenty-two programs accepted applicants directly from high school. The average program length was 83.7 weeks. Four programs offered post-diploma baccalaureate degrees in dental hygiene; one program offered a direct entry-to-practice degree program. Twenty-two (22) of the 29 programs utilized academic grades (including overall and/or prerequisite GPA) as admission criteria. Twelve programs included interviews in the admission process. A moderate correlation was observed between the number of postsecondary credits required for admission and NDHCE success rates (r = 0.6723). A weak correlation was found between program length and NDHCE success rates (r = 0.1797). Conclusion: Academic performance as an admission criterion, including overall/prerequisite GPA, was the most common criterion used by dental hygiene programs. Graduates from programs that required more postsecondary credits tended to perform better on the NDHCE. The higher success rate may be attributed to the rigour of the prerequisite courses, which may prepare students for dental hygiene studies and ultimately success on the national examination. In addition, students with more postsecondary coursework may be better adjusted to studies at a postsecondary level and/or be more experienced at taking examinations.

Objective: To evaluate the clinical efficacy and safety profile of a novel-designed isosceles-configured (SUN Teeth™) toothbrush in comparison to a standard reference toothbrush with end-rounded bristles (approved by the American Dental Association [ADA]). Methods: The sample size was determined using the G-Power-software, version 3.1.2 and, accordingly, 104 subjects (ages 19 years to 25 years) were recruited and randomized into either the test group (n = 54) or the control group (n = 50). Prior to study commencement, scaling was performed followed by abstinence from oral hygiene for 24 hours. Baseline pre-brushing gingivitis scores (Lobene) and plaque scores (Turesky modification of Quigley Hein) were recorded. Brushing was performed for 3 minutes and post-brushing scores were recorded on days 1, 14, and 28 without refraining from regular brushing. Data were analysed with Statistical Package for Social Sciences (IBM-SPSS, v.25.0). Results: Post-brushing plaque scores showed significant reduction in both groups at all time intervals. However, no significant differences between the test and control brush groups were achieved at any time points. Conclusion: The isosceles-configured SUN TeethTM toothbrush is equivalent in plaque removal to the conventional flat-bristled ADA reference brush.

Objective: The aim of this review is to explore dental hygienists’ risk for noiseinduced hearing loss (NIHL) and to describe the current hearing protection options. Methods: A literature search was undertaken using the following databases: PubMed, CINAHL, Cochrane Libraries, and Google Scholar. The returns were screened using inclusion and exclusion criteria and the remaining studies were critically appraised. Results and Discussion: Seventeen articles assessed noise levels and NIHL risk in dental settings; and 11 articles examined hearing protection devices. The literature revealed that oral health practitioners were exposed to excessive noise limits (85 dBA) in an 8-hour workday, therefore increasing the risk of NIHL. Oral health professionals need to be aware of this risk and the preventive measures they can take to reduce the potential for hearing loss. Effective preventive measures may include hearing protective devices (HPDs), educational programs, insulated noise-absorbing materials, and regular monitoring of noise exposure. Conclusion: Dental hygienists may be at risk for permanent or temporary hearing loss in their work environment. Permanent hearing loss from the use of ultrasonic scalers appears to be minimal. To prevent hearing loss, active (electronic) HPDs are recommended as they allow practitioners to protect their hearing and communicate with clients.

Introduction: Marginalized, low-income individuals face many barriers to dental care, including but not limited to cost. The Student Health Initiative for the Needs of Edmonton (SHINE) dental clinic is a student-operated volunteer clinic offering free services to low-income individuals. This study aimed to explore the access to dental care needs of low-income groups, from community health brokers’ perspectives. Case description: The study was deemed exempt from ethical approval (Pro00074745). Five semistructured interviews exploring access to dental care were conducted with health brokers purposefully selected from 4 different community outreach centres. Access was defined and analysed using Penchansky and Thomas’ theory of access as modified by Saurman. Results: Interviews revealed lack of awareness of the SHINE clinic. Translation and interpretation support was an identified need, and there was concern for clients who fear discrimination in health care settings. Conclusion: Preliminary barriers to care at SHINE were identified. However, further investigation is required to understand how SHINE aligns with population needs.

Background Two subtypes of lichenoid mucositis (LM) with oral epithelial dysplasia have been proposed, with differing risks of malignant transformation. However, no research has been done to authenticate this hypothesis. The study objective was to determine whether there are 2 subcategories within this entity, one with primary lichenoid and secondary dysplastic features (L1D2), and the other with primary dysplastic and secondary lichenoid features (D1L2), and to compare the proportion of malignant progression in these groups. Methods Patients with a diagnosis of lichenoid mucositis with low-grade (mild/moderate) oral epithelial dysplasia, no history of head and neck cancer, and who had at least 5 years of follow-up were eligible to participate in this nested case–control study. Cases (n = 10) were defined as lesions that progressed to severe dysplasia, carcinoma in situ or squamous cell carcinoma; controls (n = 32) were defined as those that did not progress. Immunohistochemistry was performed to assess for basement membrane (BM) degeneration using collagen IV—an integral BM protein. Results Lesions that progressed to cancer exhibited a similar proportion of BM degeneration at baseline (70%) compared to non-progressors (78%), with no statistically significant difference between groups (p = 0.69). Conclusion BM degeneration is frequently seen in LM with dysplasia and alone does not appear to be a predictor of malignant progression in lesions with both lichenoid and low-grade dysplastic features. Dysplasia should not be discounted in the presence of LM. Lesions that display any degree of dysplasia warrant clinical follow-up and continued monitoring.

Background: Students in the Faculty of Dentistry at the University of British Columbia have articulated challenges in understanding learning objectives in their oral epidemiology and statistics course. This study aimed to measure the impact of a course renewal intended to enhance student learning. Examples of educational interventions included providing more time for activities, increasing student interactivity, and integrating more hands-on applicable exercises using statistical software. Methods: An online mixed-methods survey using a 5-point Likert scale and open-ended questions was distributed to 43 dental hygiene students before the course renewal and again to a second cohort of 43 students after course revisions. The survey asked students to rank their levels of challenge and self-confidence in learning 23 of the course objectives throughout each academic year. Four semi-structured interviews were also conducted with faculty and staff members involved in teaching or coordinating this course to understand their experiences after the course revisions. Results: Response rates were 32% to 57%. After the course renewal, the extent to which students in the entry-to-practice cohort felt extremely challenged to learn each objective was significantly reduced (25% vs. 3%,p< 0.001), and students’ self-confidence scores significantly increased (12% vs. 30%,p< 0.001). The changes on the challenge and confidence scores in the degree-completion cohort were not statistically significant (23% vs. 24% and 31% vs. 36%, respectively). Student satisfaction levels increased in all 6 categories measured. Conclusion: Providing students with more time to absorb their learning, increasing interactivity, offering timely feedback, and integrating applicable exercises using statistical software resulted in an enhanced learning environment.

Introduction: The purpose of this research study was to develop and pilot test a culturally and linguistically appropriate oral hygiene self-care photonovel for Punjabi immigrants. Methods: Purposeful sampling technique was used to recruit 5 members of a Punjabi community organization (the Sikh Women’s Association of Montreal) for participation in 3 focus group sessions in August 2015. A thematic content analysis approach was used to sort the data, enabling identification of the storyline and photonovel contents from the themes that emerged. Comic Life 3 version 3.1.1 software was used to create a “Safeguard Your Smile” (SYS) photonovel, which was printed for pilot testing. Ten additional participants were recruited for this pilot testing, enabling further revision of the photonovel based on their suggestions. Results: Four major themes emerged from the focus group discussions: 1) lack of understanding of oral hygiene self-care and risk factors; 2) lack of oral hygiene self-care-related awareness and routine; 3) lack of emphasis on prevention by oral health care providers; and 4) perceived barriers to accessing dental health care. Thematic content analysis revealed a lack of knowledge of oral hygiene self-care skills and routine. Guided by these overarching themes, a final version of the photonovel script was created including photographs of key characters. The photonovel was subsequently printed for pilot testing. Pilot test results revealed close to 80% of participants agreed that the SYS photonovel was culturally and linguistically appropriate and easy to understand. Conclusions: A culturally and linguistically appropriate photonovel may be a useful tool for enhancing oral hygiene self-care knowledge among ethnic communities. Further studies are required to test the effectiveness of such a tool.

Background Diagnostic score reporting is one method of providing feedback to all students following a structured clinical assessment but its effect on learning has not been studied. The objective of this study was to assess the impact of this feedback on student reflection and performance following a dental hygiene assessment. Methods In 2016, dental hygiene students at the University of Alberta participated in a mock structured clinical assessment during which they were randomly assigned to receive a diagnostic score report (intervention group) or an overall percentage grade of performance (control group). The students later reflected upon their performance and took their regularly scheduled structured clinical assessment. Reflections underwent content analysis by diagnostic domains (eliciting essential information, effective communication, client-centred care, and interpreting findings). Results were analysed for group differences. Results Students performed best on eliciting essential information (92%) and poorest on interpreting findings (42%). The intervention group was more likely to view interpreting findings as a weakness, p = 0.007, while the control group was more likely to view eliciting essential information as a weakness, p = 0.04. No differences were found on the actual assessment scores, p > 0.05. Discussion Students who received diagnostic score reporting appeared to reflect more accurately upon their weaknesses. However, this knowledge did not translate into improved performance. Modifications and enhancements to the report may be necessary before an effect on performance will be seen. Conclusion Diagnostic score reporting is a promising feedback method that may aid student reflection. More research is needed to determine if these reports can improve performance.

Background Structured clinical assessments capture key information about performance that is rarely shared with the student as feedback. The purpose of this review is to describe a general framework for applying diagnostic score reporting within the context of a structured clinical assessment and to demonstrate that framework within dental hygiene. Methods The framework was developed using current research in the areas of structured clinical assessments, test development, feedback in higher education, and diagnostic score reporting. An assessment blueprint establishes valid diagnostic domains by linking clinical competencies and test items to the domains (e.g., knowledge or skills) the assessment intends to measure. Domain scores can be given to students as reports that identify strengths and weaknesses and provide information on how to improve. Results The framework for diagnostic score reporting was applied to a dental hygiene structured clinical assessment at the University of Alberta in 2016. Canadian dental hygiene entry-to-practice competencies guided the assessment blueprinting process, and a modified Delphi technique was used to validate the blueprint. The final report identified 4 competency-based skills relevant to the examination: effective communication, client-centred care, eliciting essential information, and interpreting findings. Students received reports on their performance within each domain. Discussion Diagnostic score reporting has the potential to solve many of the issues faced by administrators, such as item confidentiality and the time-consuming nature of providing individual feedback. Conclusion Diagnostic score reporting offers a promising framework for providing valid and timely feedback to all students following a structured clinical assessment.

Aim: The aim of this paper is to review the most current evidence of the nature of this relationship and examine whether non-surgical periodontal therapy (NSPT) significantly lowers glycemic (HbA1c) control. Methods: The PICO question was, “For individuals with type 2 diabetes mellitus (T2DM) and periodontitis, will non-surgical periodontal therapy (NSPT), as compared to no treatment, improve the individual’s glycemic control as measured by HbA1c.” Only systematic reviews (SRs) with or without a meta-analysis (MA) of randomized controlled trials (RCTs) or umbrella reviews of SRs and MAs of RCTs published in the English language between 2007 and 2019 were included. Several databases were searched as per their protocols. Quality assessments were conducted by both authors using the PRISMA checklist. The Bradford Hill criteria were used to determine evidence for causality. Results: Of 54 records retrieved, after elimination of duplicates and studies not meeting inclusion criteria, 5 SRs/MAs and 3 umbrella reviews of SRs/MAs were selected. All 5 SRs/MAs reported reductions in HbA1c levels 3 months following NSPT, but effect sizes were small and 2 were not statistically significant. The 3 umbrella reviews consistently reported small reductions in HbA1c, but high levels of heterogeneity and moderate to high risk of bias. The Bradford Hill criteria failed to support a causal relationship between periodontitis and T2DM. Conclusions: Whether NSPT compared with no treatment in persons with T2DM improves the individual HbA1c remains unclear as does the exact nature of the relationship between periodontitis and T2DM.

Purpose: The purpose of this qualitative descriptive study was to explore dental hygiene diagnosis (DHDx) to gain an understanding of how dental hygienists experience this phenomenon while providing dental hygiene care. Methods: A qualitative descriptive research design was employed using purposive sampling. Data were collected from semi-structured interviews with 10 dental hygienists actively practising in California, Oregon or Colorado. The interviews were audiorecorded, transcribed verbatim, and verified for accuracy. Data analysis included open coding and axial coding to determine larger, related segments of data called categories providing an overall descriptive summary of DHDx. Two independent peer examinations and member checks established validity of the data analysis. Results: Four categories emerged from the study: expertise and confidence; client communication; dental hygiene care plan; and dentists’ trust. Participants revealed that expertise and confidence in performing the DHDx was gained through clinical practice. During client care, discussing the DHDx with clients helped to make them aware of their health condition. The development of the dental hygiene care plan was based on the results of the assessment data and the DHDx. Participants stated that their employer/dentist trusted them to diagnose. Conclusions: A qualitative descriptive study was conducted to summarize dental hygienists’ experiences with DHDx in 3 US states; 4 categories emerged. The DHDx informs the client, increases understanding, and engages the client in the decision-making process. Further study is warranted to identify a more contemporary definition of DHDx and to compare how DHDx is utilized by dental hygienists in other countries.

Background: The oral hygiene habits of clients wearing fixed orthodontic appliances is poorly understood. Assessment of oral hygiene behavioural patterns is essential for understanding clients’ oral health care needs. The aim of this study was to investigate orthodontic clients’ oral hygiene behaviours, brushing techniques, and oral hygiene awareness. Methods: A total of 200 orthodontic clients wearing fixed orthodontic appliances were consecutively recruited from the Sichuan Provincial Hospital, Chengdu, China, and the Faculty of Dentistry, University of Otago, Dunedin, New Zealand. A 47-item questionnaire was used to survey study participants. Results: The survey had a 92% response rate, with 67.5% of respondents being female and 32.5% male. Most were non-smokers (94.2%) and the majority (80.0%) brushed their teeth twice daily. Most (80.4%) brushed their teeth for 1 to 2 minutes, and 68.7% positioned their toothbrush both horizontally and vertically, with horizontal being the preferred direction of motion. One-third (33.5%) did not use any auxiliary oral hygiene aids; most snacked between meals; only 31.4% received professional tooth cleaning during orthodontic treatment; and 56.8% experienced an increased level of halitosis after appliance placement. Most respondents (79.4%) thought their oral hygiene was good, but 51.0% reported bleeding gums during tooth brushing, 31.4% found they rarely bled, and only 17.6% reported no bleeding. Most respondents agreed that good oral health was very important for orthodontic treatment and that their own efforts were the most important factors. Conclusions: Client awareness of the importance of oral hygiene during orthodontic treatment requires improvement. Clinician reinforcement of oral hygiene should become a priority for orthodontic clients.

Background: Women involved with the criminal justice system are often marginalized or vulnerable and may face oral health inequities. Through a community-engaged program at a Canadian university, dental hygiene students provided preventive care at an organization supporting this population. This study explored the impact of these oral care services from client and organization staff perspectives. Methods: One focus group with 6 clients, 2-person interviews with 4 clients, individual interviews with 3 clients, and one focus group with 4 organization staff members were conducted. Discussions were audio recorded, transcribed verbatim, and analysed thematically. The concept of access, proposed by Penchansky and Thomas (1981) and Saurman (2015), was used as the conceptual framework to organize the themes. Results: Nine themes were identified from the focus group and interview discussions: limited options, convenience, realistic expectations, respect and attention, no judgement, physical environment, communication, clients’ unique needs, and appropriate messaging. Discussion: The clinic’s close proximity and services, for which women did not need to pay out-of-pocket, facilitated access to preventive care. The person-centred and trauma-informed care further facilitated access. However, access to comprehensive care through referrals was limited by cost and likely issues of stigmatization from other dental care providers. Clinic aesthetics, advertising, and communication between the students and women receiving care also hindered access. Conclusion: Preventive oral care services provided at this clinic for marginalized and vulnerable women who have been involved with the criminal justice system were valued by clients and staff. Findings will help inform future community-based dental hygiene clinics for this population.

Previous position papers have confirmed to varying degrees associations between periodontal microbes and respiratory tract infections such as nosocomial or hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), and chronic obstructive pulmonary diseases (COPD). Causal relationships have not been confirmed and have been the source of much confusion for the medical and oral health professions. Aim: to investigate whether sufficient evidence exists for a causal relationship between periodontal microbes and respiratory diseases, with a focus on HAP and VAP. Methods: The PICO question was “For patients in hospitals, nursing homes or long-term care facilities who are at high risk for respiratory infections, will an oral care intervention such as toothbrushing, administration of antimicrobial agents, and/or professional care, as compared to no oral care intervention (or usual oral care) reduce the risk for respiratory infections?” Only systematic reviews (SRs) with or without a meta-analysis (MA) of randomized controlled trials published in the English language between 2007 and 2019 were included. Databases searched included PubMed, MEDLINE, EbscoHost, CINAHL, Scopus, Cochrane Registry of Systematic reviews, and Clinical Trials Registry. Quality assessments were conducted by both authors using the PRISMA checklist. The Bradford Hill criteria were used to determine evidence for causality. Results: Of 47 respiratory studies retrieved, after elimination of duplicates and studies not meeting inclusion criteria, 10 SRs were selected, 9 of which included MAs. Although there was evidence that administration of chlorhexidine gluconate (CHX) reduced the risk for VAP, none existed for HAP. Limitations included inconsistencies among studies in population groups, CHX concentration, frequency of administration, number of applications, and insufficient evidence for use of povidone iodine or toothbrushing in ventilated patients. While some studies reported other patient-centred outcomes (i.e., ICU mortality, length of ICU stay or duration of mechanical ventilation), findings were positive only for cardiac surgery ventilated patients, who did not meet the inclusion criteria. Conclusions: Bradford Hill criteria analysis failed to support a causal relationship between periodontal microbes/oral health care and respiratory diseases such as pneumonia.

Human health is linked to environmental health. Pollutants or disease-causing microbes released into the environment through human activity or natural disasters affect communities’ air quality, water or food supply, and, ultimately, the livelihoods of residents. Oral health care (OHC) professionals, including dental hygienists (DHs), use vast amounts of resources in their daily clinical operations, which contribute to the global pollution burden and climate change. Canadian OHC professionals are largely missing from the environmental sustainability dialogue, despite their commitment to the holistic well-being of their clients and communities they support. Objective: This literature review explores the barriers to adopting environmentally sustainable (ES) initiatives in the clinical setting as perceived by OHC professionals, particularly DHs. Results: Eight studies reviewed highlight 4 key barriers—infrastructural, institutional, educational, and individual—to the adoption of ES initiatives by OHC professionals in the clinical setting. Conclusion: OHC professionals who adopt ES initiatives to curb the potential environmental impacts of their clinical practices support the population health of the communities they serve and, thus, the well-being of future generations. Further research may guide the development of education, protocol, policy, and infrastructure changes to facilitate the adoption of ES initiatives by OHC professionals even amidst ever-changing global conditions. Adopting ES initiatives not only benefits the environment, but it may also aide in improving client outcomes due to long-term practice savings that can be diverted to enhancing client care.

Background: Dental hygiene is a physically demanding profession that places dental hygienists at risk of musculoskeletal disorders (MSDs). Study objectives were to establish the patterns and frequencies of self-reported occupation-related MSDs among dental hygienists in Canada and determine what MSD prevention training is provided in the curricula of accredited dental hygiene schools in Canada. Methods: An online, quantitative cross-sectional survey was distributed to registered dental hygienists in Canada to assess prevalence and types of occupational MSDs. Additionally, a phone/email qualitative structured interview was conducted with 8 accredited English-speaking dental hygiene schools across Canada. Results: Of all respondents (N = 647), 83% (n = 534) reported a work-related MSD. The most common disorders were carpal tunnel syndrome and tendonitis. There was a positive correlation between number of years in practice and the incidence of MSDs. Half of the respondents felt they had received adequate training on injury prevention. Most schools interviewed felt their injury prevention training was adequate. Discussion: Despite the majority of dental hygiene programs in Canada feeling they provide adequate training for injury prevention, an alarmingly high prevalence of occupation-related MSDs was found among dental hygienists in Canada. This finding is concerning given that 61% (n = 396) of respondents had practised for less than 10 years. Conclusion: The high prevalence of MSDs among dental hygienists in Canada indicates the need for further exploration of ergonomics in the work environment and possible individual predisposing factors for MSDs. Additionally, dental hygiene programs should conduct an in-depth examination of their curricula as it relates to ergonomics and injury prevention.

Objective: This project compares the cost effectiveness of a preventive fluoride varnish (FV) program with usual dental care (surgery under general anesthesia [GA]) for preschool children in 2 low-income communities in Winnipeg, Canada. Methods: Program impact is described in terms of cost, cavities avoided, and reductions in surgery volume. Aggregate data for 873 children ages 1 to 6 years old enrolled in the Winnipeg Regional Health Authority Daycare Fluoride Varnish Program in January 2018 were analysed using a Markov model. Results: The program was found to save approximately $822.98 per child over 5 years versus usual dental care. There were 4.38 cavities avoided per child and a savings of $187.71/cavity for the FV group. Participants’ need for dental surgery under GA was reduced from 19.1% in the usual care group to 1.6% in the FV group (92% reduction) over 5 years. Sensitivity analyses using a Monte Carlo simulation showed that the program was cost effective over usual care 100% of the time. Finally, it was estimated that the program had saved $753,000 since its inception, or approximately $41.15 per FV application. Conclusion: The FV intervention had better health outcomes, lower costs, and was less invasive than usual care involving dental surgery under GA for children enrolled in the program.

Background: Epidemiological studies have shown that illicit drug use is a persistent and growing problem in our society. Methamphetamine and cocaine are at the top of the list of stimulants commonly abused. There is a need for a disease-targeted approach to the dental management of clients who use these drugs. Method: A review of the literature was conducted to identify the most upto-date information for the diagnosis and treatment of dental clients who abuse methamphetamine and cocaine. Databases in the University of Toronto library system were searched for peer-reviewed articles, written in English, and containing data relevant to clinical decision making. Textbooks were chosen from a list of reference materials provided by the National Dental Examination Board. All cited articles were published within the past 5 years. Results and Discussion: There is robust literature on the treatment of individual signs and symptoms associated with ethamphetamine and cocaine use. However, there is a dearth of information on the comprehensive, client-centred oral health care that these individuals require. Conclusion: This article reviews the best practices to guide the clinician from the initial oral diagnosis appointment to the maintenance of care, including the pharmacological actions of these drugs of abuse, the specific challenges faced in providing care for this client population, and scientifically based treatment considerations to maximize prognosis.

Objective: The purpose of this review is to explore the literature on continuous assessment in the evaluation of clinical competence, to examine the variables influencing the assessment of clinical competence, and to consider the impact of high-stakes summative assessment practices on student experiences, learning, and achievement. Methods: A literature search of CINAHL, PubMed, ERIC (EBSCO), Education Source, and Google Scholar was conducted using key terms. Articles reviewed were limited to full-text, peer-reviewed articles published in English from 2000 to 2019. Selected articles for this review include a meta-analysis, systematic reviews, and studies using qualitative and quantitative designs. Results: Findings reveal that current assessment practices such as one-time high-stakes assessments in the evaluation of clinical competence are influenced by several variables: interexaminer differences in evaluation, variability with non-standardized client use in assessment, the failure to fail, and the impact of stress on performance outcomes. This literature review also highlights a programmatic assessment approach in which student competence is determined by a multitude of low-stakes assessments over time. Conclusion: A review of the literature has highlighted current methods of clinical assessment relying on traditional, summative forms of evaluation, with reliability and validity of the assessment influenced by several variables. Emotions and student experiences related to one-time high-stakes summative assessments may negatively affect student learning and achievement outcomes. The design, implementation, and use of assessment practices within a competency-based education framework warrants

Previous position papers have confirmed associations between periodontal disease and adverse pregnancy outcomes. Causal associations have not been confirmed and have been the source of much confusion for the profession and public. Aim: To investigate whether sufficient evidence exists for a causal relationship between periodontal disease and adverse pregnancy outcomes. Methods: The PICO question was “For adults in good general health who are diagnosed with periodontal disease, will receiving non-surgical periodontal therapy (NSPT), as compared to not receiving non-surgical periodontal therapy, lower their risk for adverse pregnancy outcomes?” Only systematic reviews (SRs) with or without meta-analyses (MAs) of randomized controlled trials published in the English language between 2007 and 2019 were included. Databases searched included PubMed, MEDLINE, EbscoHost, CINAHL, Scopus, Cochrane Registry of Systematic Reviews, and Clinical Trials Registry. Quality assessments were conducted by both authors using the PRISMA checklist. The Bradford Hill criteria were used to determine evidence for causality. Results: Of 37 records retrieved for adverse pregnancy outcomes, 9 met the criteria for inclusion and were analysed. None showed that NSPT lowers the risk for adverse pregnancy outcomes. Conclusions: Bradford Hill criteria analysis failed to support a causal relationship between periodontal disease and adverse pregnancy outcomes based on the most current evidence available.

Objective: People living with HIV/AIDS (PLWHA) have difficulty accessing oral health services primarily due to HIV-related stigma and discrimination. In 2011, the University of British Columbia (UBC) Dental Hygiene Degree Program implemented a preventive oral health services program at the Positive Living Society of British Columbia (PLSBC), a non-profit organization supporting PLWHA. This study aims to assess the perception of how this type of service delivery influenced access to oral health care for members of PLSBC. Methods: Personal interviews with 10 members and one focus group comprising 12 staff were conducted. Audiorecordings were transcribed verbatim and coded thematically. Emerging themes were identified using the interpretative phenomenology approach following Penchansky and Thomas’ theory of access. Results: The program helped members maximize their dental coverage to receive other types of dental services. Members who were influenced by past traumatic experiences appreciated that services were delivered in a safe manner and in a stigma-free setting. Members valued the opportunity to educate future dental professionals to reduce HIV-related stigma. However, dental needs that could not be addressed by the program remained untreated for some members who continued to face barriers to care at referral clinics. Conclusion: This community-based preventive dental program provided affordable dental care, a stigma-free setting, care delivered in a safe manner, an educational opportunity, and accessible location, which all seemed to have a positive influence on access to oral health care for members of PLSBC. However, the limited availability of the program prevented many members from accessing comprehensive oral health care and is a factor that should be addressed.

Background: Contemporary student demographics in institutions of higher learning include the mature female student. Preparing to enter an academic setting after an extended absence or for the first time can create personal role conflicts for this student cohort. The purpose of this study was to develop a more comprehensive understanding of the family-life roles, student experiences, and different coping mechanisms of mature female dental hygiene students in order to better enable and support individual student success. Methods: This study employed a mixed methods explanatory approach whereby quantitative data were obtained from mature female dental hygiene students (N = 12) via a 10-item questionnaire comprising both closed- and open-ended questions. Closed-ended questions were summarized using descriptive statistics. Open-ended questions were examined for common themes. Additional qualitative data were obtained through personal in-depth interviews examining supplementary common themes. Results: “Mothering” was identified as the primary family role both prior to and during school enrolment. All participants identified “time” as the greatest challenge and role conflict as being self-imposed. The prime benefit reported was increased self-confidence. The educational system offered the least amount of support according to respondents. Conclusions: The mature female student requires support when returning to higher education—from herself, family, and the academic setting. Institutions of higher education should be cognizant of specific characteristics, barriers, and challenges any student encounters to help facilitate student success.

Background: The use of medicated mouthwashes and gels in the home care maintenance of dental implants is controversial due to the possibility of residue deposition on the implant collar. The aim of this in vitro study was to analyse, by means of scanning electron microscopy (SEM), the amount of residues on dental implant collars treated with various commercial home dental care products. Methods: Gel and mouthwash products were tested on 10 implants. The gels included sodium fluoride, amine fluoride, and sodium hyaluronate products. The mouthwashes tested contained triclosan, nimesulide, stannous fluoride, amine fluoride, and hexetidine-chlorobutanol. The SEM observations were performed at different magnifications in double modality SE (secondary electrons) and BSE (backscattered electrons) to qualitatively assess any residual products. The image quantitative analysis was performed by Image J® software to assess areas occupied by residuals. All results were analysed by the same researcher with experience in electron microscopy. Results: The fluoride-based gel products left wider areas occupied by residuals than the mouthwash products. In particular the fluoride-based and hyaluronate products left the highest amount of residues. Among mouthwashes, fluoride-based and triclosan products showed the highest amount of residuals deposition. Discussion: Oral hygiene procedures and related professional products are fundamental to the prevention, treatment, and control of microorganisms. In the case of implants, mechanical and chemical plaque control strategies are even more important since the potentially harmful biofilm covers abiotic titanium surfaces. In situ fixture maintenance is crucial for dental implant therapy success. Correct recommendation of home care products for bacterial control is fundamental to the health of implants and their surrounding tissues. Conclusions: Data from this experimental study showed that home care commercial products in gel formulation, especially those containing fluoride, leave more residuals on titanium smooth surfaces than mouthwash products. The longer permanence of the products may lead to a more effective plaque control than other products.

Previous position papers have confirmed associations between periodontal disease and cardiovascular disease. Causal associations have not been confirmed and have been the source of much confusion for oral health professionals and the public. Aim: To investigate whether sufficient evidence exists for a causal relationship between periodontal disease and cardiovascular disease. Methods: The PICO question was “For adults in good general health who are diagnosed with periodontal disease, will receiving non-surgical periodontal therapy (NSPT), as compared to not receiving NSPT, lower their risk for cardiovascular diseases?” Only systematic reviews (SRs) with or without meta-analyses (MAs) of randomized controlled trials published in the English language between 2007 and 2019 were included. Databases searched included PubMed, MEDLINE, EbscoHost, CINAHL, Scopus, Cochrane Registry of Systematic Reviews, and Clinical Trials Registry. Quality assessments were conducted by both authors using the PRISMA checklist. The Bradford Hill criteria were used to determine evidence for causality. Results: Of 53 cardiovascular disease studies retrieved, 7 met the inclusion criteria, of which 6 contained MAs. Results were mixed for various periodontal interventions lowering the risk for cardiovascular outcomes. Only one SR used cardiovascular events as a direct outcome; the other 6 used various surrogate measures. Conclusions: Bradford Hill criteria analysis failed to support a causal relationship between periodontal disease and cardiovascular disease.

Research on dental and dental hygiene education is key to improving learning, teaching, and oral health care in academic dental institutions. Faculty should be able to write research proposals and reports properly to secure funding for research and share the findings of studies with stakeholders. Specifically, they should demonstrate why the study matters in the introduction section of their text. Our experience in mentoring dental and dental hygiene faculty shows that some have difficulty justifying the importance of their studies due to the way they approach the introduction section. This short communication provides 3 recommendations to help faculty approach and write this section adequately, which can be useful for writing other sections of manuscripts and grant applications.

Background: Static positioning and awkward postures put dental hygienists at risk for work-related musculoskeletal disorders. These disorders often appear during professional training programs. Ergonomics education has been shown to reduce the incidence of injuries, but fitness training to improve postural awareness and endurance is not typically included in dental hygiene curricula. This study assessed the effects of a 12-week functional fitness training program on ergonomic and postural knowledge, outcome expectations and self-efficacy related to exercise, and core stability in final-year dental hygiene students. Methods: Participants (n = 24) completed surveys and core stability tests and demonstrated postural movements before and after completing a mandatory weekly training program focusing on dynamic core stabilization, aerobic exercise, and postural awareness. Results: Participants improved static plank hold time and left leg forward lunge scores, with no significant changes in right lunge or stability push-up tests. Accuracy in demonstrating postural movements in response to verbal cues improved for 2 of 6 movements. Knowledge about injury risk factors and body mechanics was relatively high at pre-test and did not change post-test. Outcome expectations and self-efficacy were not significantly different from pre- to post-test. Conclusions: Functional fitness training resulted in increased core endurance and improved execution of some movement patterns associated with good body mechanics. Our study provides evidence for the inclusion of this type of conditioning program in the dental hygiene curriculum. Further research, including more sensitive tests of physical function as well as the transfer of knowledge and safe postures into clinically relevant situations, is warranted.

Objectives: To explore the perceptions of oral health and access to care experiences of men with a history of incarceration and to identify factors contributing to current oral health inequities within their community. Methods: A qualitative approach was used via focus group discussions among 18 men with a history of incarceration and 10 staff members of a non-profit organization working with individuals who are involved in or at risk of involvement with the criminal justice system. All discussions were audiorecorded and transcribed verbatim. A thematic analysis was undertaken using N-Vivo 10™, a qualitative data management program. Results: The participants ranged in age from 29 years to 69 years, came from a variety of ethnic backgrounds, and had different prison setting experiences. Five major themes emerged: not on the radar, stigma of incarceration, being shot down, caught in the system, and institutional conditioning. Conclusions: The personal backgrounds, experiences with health and dental care during prison time, and the unique challenges faced by men with a history of incarceration influenced their perceptions and their ability to access dental services. Dental professionals can help to change these perceptions and experiences by creating a safe space for these individuals to access and receive care comfortably.

Background: Swimming is known worldwide as one of the healthiest, lowimpact forms of exercise that promotes a strong body, heart, and mind. However, several studies have suggested that swimming pool chlorination is responsible for dental erosion, calculus formation, and stain in competitive and recreational swimmers, a phenomenon known as swimmer’s mouth. The purpose of this observational study was to assess chlorine stain on the dentition of competitive female swimmers and divers from a university team and to determine if dental preventive practices affected chlorine stains. Methods: Swimmers were recruited from the University of New Mexico Swimming and Diving Team for this IRBapproved study (#17-481). Participants completed a questionnaire regarding individual oral habits and frequency of preventive visits. Following the questionnaire, an oral screening was completed to evaluate for stain. Fisher exact tests, nonparametric Wilcoxon tests, and descriptive statistics were used to analyse the data. Additionally, a cross-sectional analysis was used to compare the chlorine stain between divers and swimmers. Results: Twenty-one females, with a mean age of 20.5 years, participated in the study. One hundred percent of these subjects had staining of the teeth, despite the fact that 85% of them reported brushing their teeth 2 to 3 times per day, and 81% reported receiving regular dental prophylaxis. All participants swam 5 or more times every week, with practice length ranging from 1 to 2 hours. There were no differences in stain between collegiate swimmers and divers. Conclusion: Within this study sample, extrinsic staining of the teeth was identified on all swimmers and divers and the presence of stain was not prevented by the frequency of tooth brushing or professional stain removal. Additional oral hygiene regimens should be explored to facilitate the prevention or complete removal of swimmer stain.

Depression is a common mental illness affecting millions worldwide. It is characterised by several symptoms including persistent sadness, constant irritability, and the loss of interest in pleasurable activities. The medical management of depression includes psychotherapy and pharmacotherapy. Depression is associated with numerous oral findings such as diminished salivary flow, rampant dental decay, advanced periodontal disease, and oral dysesthesias. Many of the oral findings in clients with depression can be due to the disease itself or to the treatment used for the condition; it can be difficult to determine which came first. Dental practitioners need to be aware of these orofacial findings and to treat and manage these clients appropriately. This short communication reviews the pharmacotherapy of depression and the effects of the drugs commonly used. Necessary dental treatment modifications for clients with depression are discussed.

Background: Residents living in long-term care facilities have an increased risk of developing oral diseases and exacerbating existing systemic conditions. Major factors in oral health outcomes include a lack of access to dental care, varying levels of dependency, and comorbidities. While oral health can be maintained through the delivery of daily oral care, it is often insufficient. Objective: This literature review examines the effectiveness of theoretical education versus clinical skills training in improving oral care delivery abilities of care aides and seniors’ oral health outcomes. Results: Adjunctive strategies to include theoretical education and clinical skill refinement have the highest potential to enhance longterm outcomes. Discussion: A major factor in the efficacy of oral care delivery are the attitudes of care aides. With the integration of oral health assessment tools into care practices, care staff may learn to recognize oral diseases and determine the oral health needs of residents. Furthermore, oral health professionals should recognize the responsibility they have in supporting care staff throughout geriatric care.

Background: A predominantly clinical dental hygiene refresher course for dental hygienists seeking re-entry into practice was offered in Alberta for over 15 years. Because of the varied educational and practice histories of course participants, however, a newly developed dental hygiene refresher course incorporated a 3-month online component to be completed prior to the clinical practicum. Kern, Thomas, and Hughes’ 6-step curriculum development approach (2009) guided the online program design, and Olmstead’s framework for preparing professionals (2010) guided the development of learning activities specific to dental hygienists. Objective: This project aimed to determine how course participants perceive the interactive online learning activities of the refresher course and to assess their perception of preparedness for the clinical practicum. Approach: This 2-part program evaluation included a post-course group session with participants and clinical instructors and the Distance Education Learning Environments Survey (Walker & Fraser, 2005) which measures student perceptions of instructor support, student interaction and collaboration, personal relevance, authentic learning, active learning, and student autonomy. Results: Sixteen participants completed the new refresher course from March through June 2019. Three clinical instructors also provided post-course feedback. Participants reported feeling prepared for clinical sessions; valued flexibility and independence of online learning; and appreciated online interactions with fellow course participants prior to meeting face-to-face in clinics but requested more case studies, fewer small assignments, and questioned the relevancy of some assignments. Clinical instructors reported participants came prepared with updated knowledge for the clinic sessions after completing the online activities. Conclusion: The 3-month online course with self-paced asynchronous activities improved preparation of participants for the onsite clinical practicum. Participants valued the interactive learning activities and convenience of distance education. However, they also made recommendations for future changes. Phase 2 of the evaluation provided increased understanding of participants’ perceptions of the overall course experience and their resulting performance during the onsite clinical practicum. The combined feedback will allow for further enhancements to the refresher course to ensure appropriate review and preparation by participants for the course and for successful re-entry into dental hygiene practice.

Objective: Oral epithelial dysplasia (OED) is recognized as potentially malignant. However, when dysplasia coincides with striking lichenoid changes, the cellular atypia is often discounted as reactive. The objective of this literature review was to assess the malignant potential of OED with striking lichenoid features (lichenoid dysplasia, LD), compared to OED without lichenoid features. Method: A systematic search of electronic databases was conducted using PubMed and MEDLINE EBSCO. The following key words were used: [“lichenoid dysplasia” OR “lichenoid mucositis”] AND [“progression” OR “cancer”]. The references and bibliographies of included studies and papers were also scrutinized. English-language, full-text, primary, peer-reviewed publications were included in this literature review. Review articles and papers that did not answer the primary research question were excluded. Results: The search strategy produced 68 articles, 7 of which met the inclusion and exclusion criteria: 3 molecular studies investigating the expression of biomarkers implicated in cancer progression, 2 case reports of LD that progressed to oral squamous cell carcinoma, and 2 retrospective studies, one of which compared clinical and histological characteristics of LD and OED, while the other investigated the proportion and rate of malignant transformation of both LD and OED. Conclusion: Variability in diagnostic criteria and inadequate documentation contribute to the ongoing debate regarding the malignant potential of LD. However, most studies support the finding that OED has malignant risk, regardless of lichenoid changes. Welldesigned prospective studies are required to further investigate the malignant potential of LD.

Objective: To determine the extent of the difference in health complications among a population of individuals with diabetes who report “poor to fair” versus “good to excellent” oral health. Method: A prospective cohort study was undertaken of individuals with diabetes from the Canadian Community Health Survey 2003 and 2007–2008 (N = 5,183). Self-reported oral health was linked to electronic health records. Participants under the age of 40, missing self-reported oral health, and those who could not be identified in linked databases were excluded. Diabetes complications were extracted from health records based on ICD codes. A series of Cox Proportional hazards and multinomial logistic regression models were constructed to determine the risk of diabetes complications and the odds of acute or chronic complications, respectively. Participants who did not experience any diabetes complication were censored at time of death or at the study termination date (March 31, 2016). Models were adjusted for age and sex, followed by social characteristics (income, education, ethnicity, and rural vs urban living) and behavioural factors (smoking status, alcohol consumption, physical activity, and dental visits). Results: Diabetes complications among participants differed by self-reported oral health. For those reporting “poor to fair” oral health, the hazard of a diabetes complication was approximately 30% greater (HR 1.29 95%CI 1.03, 1.61) than for those reporting “good to excellent” oral health, in a fully adjusted model. For those reporting “poor to fair” oral health, the odds of an acute and chronic complication were approximately 10% (OR 1.10 95%CI 0.81, 1.51) and 34% greater (OR 1.34 95%CI 1.11, 1.61), respectively, in a fully adjusted model. Conclusion: Oral health status is associated with diabetes complications and it appears that this link is influenced by the chronic nature of the periodontitis–diabetes link. This study is the first to explore the oral health–diabetes health link among individuals with diabetes in Ontario, Canada.

Background: Head and neck cancer (HNC) accounts for approximately 4% of all new cancer cases in Canada and 3% of all cancer deaths. While a moderate decrease in HNC has been documented, the incidence of oropharyngeal cancers related to human papillomavirus (HPV) is increasing and is predicted to surpass the prevalence rate of cervical cancer by 2020. Radiation therapy is often used in the treatment of HNC, resulting in acute and chronic side effects. Educating clients to seek pre- and postradiation treatment dental care is essential to mitigate oral complications. Routine HNC screenings facilitate earlier detection and can improve survival rates. Objective: This interprofessional student collaboration session was created for dental hygiene (DH), radiation therapy (RT), and medical laboratory science (MLS) students to better understand the client’s cancer care experience, beyond the DH/RT/MLS points of practice. Approach: The first time the session was offered, RT and DH students completed pre-session and post-session surveys. In 4 separate stations, students role-played client education scenarios and identified and described their unique roles and respective responsibilities in a client’s oncological journey, before, during, and after treatment. Following the session, students participated in a question-and-answer discussion. The second year, we offered 2 sessions instead of one, included MLS students as well as client partners who had been diagnosed with HNC, and made use of the university’s Linear Accelerator Training Suite in hopes of accommodating deeper learning about person-centred care. Evaluation: All students indicated that they learned a significant amount about the client experience during cancer care and about HNC multidisciplinary care specifically. They articulated feeling more confident in providing clients and their families with mindful, empathetic, high-quality care.

Objectives: Calculus is a calcified mineralized plaque that plays an important etiological role in periodontal diseases. Most anticalculus agents in toothpaste prevent calculus but barely remove existing calculus and may damage tooth structures. The purpose of this randomized controlled clinical study was to test the efficacy of a newly developed anticalculus toothpaste (D-Tart toothpaste) in removing calculus and dental stains compared to Crest antitartar toothpaste. Method: The study design was reviewed and approved by the Research Ethics Board at McGill University (application A08-M35-16B), and all study participants signed informed written consents before their participation. Eighty-three clients who fulfilled the inclusion criteria were blindly and randomly assigned to 2 study groups. Forty-two participants received the intervention (D-Tart toothpaste), and forty-one received the control toothpaste (Crest toothpaste). Calculus, stain, QHI plaque, and gingival indices scores were recorded and compared at baseline, 3, 6, and 9 months, using a generalized linear model analysis with the Wald Chi-Squared Test. Scaling and polishing were offered to all participants at the 3-month visit and the end of the study. Results: At 3 months, the intervention group showed 32% less total calculus compared to the baseline mean score (p = 0.0007) and 59% less total calculus compared to the control group (p = 0.0001). Over the 9 months, the mean calculus score for Crest users was 79% higher than for D-Tart users (p = 0.0008). There was a significant improvement in the gingival health of D-Tart users compared to the Crest group at all intervals. However, both toothpastes were comparable in terms of stain removal, which was significantly lower than at baseline (p < 0.0001). Evaluation: D-Tart toothpaste shows superior efficiency in removing and preventing calculus accumulation than the control toothpaste, and it could be helpful in preventing stain formation after 9 months of use.

Objective: This project aimed to examine the variation in admission criteria used by Canadian dental hygiene (DH) programs and determine whether these criteria are predictive of student success on the National Dental Hygiene Certification Examination (NDHCE). Method: Because this study was deemed outside the mandate of the Research Ethics Board, ethics approval was waived. Admission criteria were compiled from websites of 30 English-language DH programs. Data collected included secondary and post-secondary prerequisite courses, total required post-secondary credits, entrance average/GPA, interview and/or essay, and any other non-cognitive requirements. DH programs were contacted by email or phone to obtain information not available on the websites. The 2015–2017 NDHCE school results were collected from the National Dental Hygiene Certification Board’s website. The association between admission criteria and NDHCE school success rate was determined by calculating Pearson’s product-moment correlation coefficient. Results: A strong correlation was found between the number of post-secondary prerequisite credits required and NDHCE success rates (r = 0.674). There was a weak correlation between program length and NDHCE success rates (r = 0.177). Admission criteria included academic performance, non-cognitive requirements, and standardized testing. Academic performance as an admission criterion, which included GPA or high school averages, was the most common criterion used. Conclusion: Graduates of programs that required more post-secondary prerequisites may fare better on the NDHCE because the rigour of the prerequisites may have removed lower performing students from the applicant pool. Various interview processes were used by DH programs, with each type capturing different attributes. Standardized testing may equalize the discrepancies in grades from prerequisites obtained from different institutions. Due to variation in selection processes for DH programs, it is difficult to isolate variables that are predictive of success on the NDHCE. However, academic criteria such as the number of prerequisite credits required may predict DH student success.

Objective: The purpose of the study was to explore the family-life roles and experiences of mature female dental hygiene students, as well as the different mechanisms used for coping with role conflict in order to better enable and support individual student success. Methods: This study employed a mixed-methods explanatory approach whereby quantitative data were obtained from mature female dental hygiene students (N = 12) via a 10-item questionnaire comprising both closed and open-ended questions. Closed-ended questions were summarized using descriptive statistics. Open-ended questions were examined for common themes. Additional qualitative data were obtained through personal in-depth interviews examining for supplementary common themes. Results: These females identified “mothering” as their primary role prior to entering school and while attending school. All participants indicated the greatest challenge was “time”—time to be a parent, time to complete household responsibilities or time to complete academic work. Yet the prime benefit reported was increased self-confidence. Role conflict was self-imposed. The coping strategy of role redefinition was found to be most beneficial to support change, growth, and development. The educational system offered the least amount of support according to these respondents. Conclusion: The mature female student requires support when returning to higher education. Institutions of higher education need to be cognisant of specific characteristics, barriers, and challenges any student encounters to facilitate their success.

Background & Objectives: Many nursing home residents do not receive adequate oral care from staff. When teeth and dentures are not cleaned regularly, risks increase for caries, gingivitis, oral infections, respiratory pneumonia, diabetes, heart disease, lowered nutrition, and reduced social interactions. The objective of this study was to determine which of 2 methods of in-service training could be effective in motivating staff to carry out oral care with resistant residents. Methods: Following ethics approval from the researchers’ university and from participating nursing homes, 6 nursing homes in New Brunswick were randomly assigned to 1 of 2 methods of in-service training—a traditional lecture session about the importance of oral health or a new discussion-based session that addressed staff questions, concerns, and past experiences with residents who resisted oral care. In total, 40 staff members received the traditional method of training and 64 participated in the discussion session. Trained dental hygienists measured the oral status of residents at time of training and 4 weeks post-training to index the quality of oral care carried out following training. Three indices were utilized: Gingival Index (GI), Simplified Oral Hygiene Index (OHI-S), and Denture Oral Hygiene Index (OHI-D) [developed by the first author]. Immediately following training, staff filled out a 9-item Likert survey developed for this study that included questions about satisfaction with the training, usefulness of the strategies discussed, and confidence in providing oral care. Results: Two 2 (Training method) x 2 (Time of measurement) ANOVAs yielded significant interactions for biofilm and calculus, indicating that the discussion training resulted in superior oral care. Staff members were equally satisfied with both types of training. Conclusion: Training focusing on practical techniques for providing care that is safe for both the resident with dementia and the staff member may be more effective than traditional approaches, which often focus on the health consequences of not providing adequate oral care.

Objective: Dental magnification loupes may be a source of cross contamination. The primary objective of this pilot project was to evaluate the efficacy of infection control protocol used by third-year dental students. A secondary objective was to determine if a type of procedure could be predictive of contamination. Methods: Loupes (N = 25) were swabbed at baseline, wiped with disinfectant, and swabbed again. Students used the loupes for 5 days, after which the loupes were swabbed again. Students followed standard disinfection protocol and were not informed of the purpose of the study. Samples were cultured on blood agar plates and incubated (370C) for 1 to 2 days in aerobic and anaerobic environments. The numbers of microbes from each sample were enumerated by viable cell count. McNemar’s test was used to compare the proportion of contaminated loupes at baseline and day 5. Backward stepwise (Wald) logistic regression was conducted to determine if type of procedure performed was a predictor of contamination at day 5. Results: Viable cell counts ranged between 0 and >200. Loupes were classified as not contaminated (0 to 20 colonies), moderately contaminated (20 to 100 colonies) or highly contaminated (>100 colonies). At each time point, 40% of loupes were either moderately or highly contaminated with aerobic and/or anaerobic bacteria. There was no change in the proportion of loupes contaminated between baseline and day 5 (p = 1.000) for either bacteria. Overall, 36% (n = 9) of student loupes were uncontaminated at both time points, 16% (n = 4) were contaminated at both times points, and 48% (n = 12) were contaminated either at baseline or day 5. The only procedure that was a significant predictor of contamination was if a restoration was performed on day 5 (immediately before loupe collection) (p < 0.01). Conclusion: The data suggest that only 36% of students consistently followed disinfection protocols. Future study is needed to determine which types of procedures cause the greatest amount of contamination.

Objective: The objective of this study was to evaluate the impact of preclinical peer assessment on the creation of Class II composite restorations on tooth #15(MO) and #46(MOD), including rubber dam, tofflemire, and matrix band placements. Methods: A quasi-experimental design was chosen for this study, which utilized a convenience sample of 20 dental hygiene students enrolled in the winter 2018 Restorative Dentistry course at John Abbott College. Can J Dent Hyg 2019;53(3): 183-188 187 Participants were randomly divided into a control group (n = 10; no peer assessment) and an experimental group (n = 10; peer assessment). Quantitative and qualitative data were collected from both research groups. Quantitative data analysed the effectiveness of peer assessment on students’ performance score in creating acceptable Class II composite restorations on tooth #15(MO) and #46(MOD) and the qualitative data consisted of responses to 8 questions adapted from the Clinical Teaching Preference Questionnaire (Iwasiw & Goldberg, 1993) using a 5-point Likert scale ranging from strongly agree to strongly disagree and 3 open-ended questions using an anonymous online survey to assess students’ perception of peerassessment practice trials. A t-test (Two-Sample Assuming Equal Variances) was performed comparing the control and experimental group performance scores on precognitive, psychomotor, and procedural tests. All responses remained confidential. The study received ethics approval from John Abbott College’s ethical committee, certificate number JACREB201711. Results: The results showed that peer assessment did not significantly improve students’ ability to create acceptable Class II composite restorations. A possible explanation might be the short time (2 weeks) that the experimental group had to gain experience as evaluators. However, students did benefit from the peerassessment strategy as was supported by their responses to the open-ended questions. With its small sample size, short training time, and low number of peer-assessment encounters, this study’s findings cannot be generalized. Although these results were not very encouraging, it was the first peer-assessment implementation in dental hygiene education. Conclusion: While this study did not find a positive impact of peer assessment on the achievement of performance scores, it did partially substantiate the benefits of peer-assessment use when creating Class II composite restorations, based on students’ perceptions. Further research in the dental hygiene field would be of a great help to investigate the impact of peer assessment in students’ active learning.

Objectives: 1) To establish the patterns and frequencies of self-reported occupation-related musculoskeletal disorders (MSD) among dental hygienists in Canada; 2) To identify strengths and weaknesses of MSD prevention training in accredited dental hygiene program curricula. Methods: An online survey was distributed via Canadian Dental Hygienists Association social media webpages to registered dental hygienists in Canada. The survey asked questions on demographics, practice history, MSD history, preventive measures, and injury prevention curriculum. Phone and email interviews were conducted with representatives from 8 accredited, English-speaking dental hygiene schools in Canada. Interviews covered questions on injury prevention curriculum. The study was approved by the university’s Research Ethics Board (#DENTUNIT2018-04). Results: There were 647 respondents to the survey. Years in practice ranged from less than 1 year to more than 21 years, with 61% having practised for less than 10 years. Most (60%) worked full time. Eighty-three percent of respondents had suffered from an MSD related to their dental hygiene career. The most common region of injury was the neck, followed by the wrist/hand. The most common diagnoses were tendonitis and carpal tunnel syndrome. There was a positive correlation between number of years in practice and the presence of injury (r = 0.238, p < 0.001). Half of respondents felt that they had been adequately trained on injury prevention. Five of eight dental hygiene schools felt their injury prevention curriculum was sufficient. Identified program strengths include a focus on fitness and self-care, extensive preclinical and clinical training with a focus on positioning and technique, and calibration of instructors to assess ergonomics. Suggestions for improvements were as follows: dedicated ergonomics courses, injury prevention tools, and education on specific MSD and ways to prevent them. Conclusion: This survey found an alarmingly high prevalence of MSD among Canadian dental hygienists. This is particularly concerning given the relatively low number of years in practice of the respondents. Despite generally positive views on the current state of injury prevention training, these data suggest that improvements are needed.

Objective: This study aimed to identify the barriers to dental care utilization faced by individuals with autism spectrum disorder (ASD) in comparison with individuals without ASD. Method: A case-control study of 105 ASD and 100 healthy individuals was conducted to compare their oral health knowledge and dental care challenges. Data collection was made by a self-designed questionnaire. The questionnaire’s content validity was established by a panel of experts. The questionnaire was pilot tested using 5 ASD caregivers who were asked to answer the questionnaire and provide feedback. Test-retest reliability was achieved by administering the questionnaire twice to the same individuals (n = 5). Lists of special-care centres associated with ASD were obtained from the Ministry of Social Development. Similar questionnaire forms (without a few questions specific to children with ASD) were sent to parents of children without ASD studying at schools in the same region of the special-care centres. Results: Fewer ASD individuals brushed their teeth once or twice daily (31.5%), compared to the control group (41.9 %). Intake of sweets and soda more than once a day was higher among ASD individuals (43.5%, 32.2%) than among the control group (37.2%, 30.9%) respectively. The least common reason for a dental visit among individuals with ASD was for a routine check-up. Barriers such as embarrassment (43.5%), lack of specialist dental staff (28.6%), lack of knowledge of how to treat clients with disabilities (26.6%), and inadequate facilities (34%) are significantly (p < 0.05) higher among individuals with ASD than the control group. Conclusion: Knowing the factors that are associated with dental care for ASD individuals may assist in reducing barriers to dental care utilization. This study may guide the development of resources to enhance access to dental services and reduce the incidence of oral diseases and increase tooth retention among this population.

Background: In 2017, Canada accepted 320,000 new immigrants. This vulnerable population faces many barriers to receiving oral care. Objective: The purpose of this study was to determine the oral health status of recent refugees to Nova Scotia with the intent of providing data to help inform provincial oral health care policy. Methods: Approval was granted by the Dalhousie University Research Ethics Board (REB #2018-4444). Participants were recruited from a list of clients who were treated in the Refugee Oral Health Clinic at Dalhousie University from September 2017 to April 2019. Each participant completed a questionnaire that included questions about demographics, oral hygiene habits, and professional oral care. A clinical oral examination that included probing depths, clinical attachment loss (CAL), calculus, debris, gingival status, and decayed, missing and filled teeth (DMFT) was completed by second-year dental hygiene students and verified by a single calibrated professor at the Dalhousie University Dental Clinic. A one-sample Chi-squared test was conducted to compare the clinical data, and one-sample t-tests used to compare DMFT to national data derived from the 2007–2009 Canadian Health Measures Survey. Results: 91.9% of new refugees to Nova Scotia are unemployed, and 71.7% visit a dentist for emergency care only. One hundred percent reported not having insurance for oral care. Of the participants, 95.6% have probing depths greater than 4 mm and 89.7% have CAL greater than 4 mm compared to only 20.1% and 15% of the Canadian population. Debris and inflammation scores for the refugee population were moderate to severe compared to mild for the Canadian population. The refugee population had more decayed and missing teeth than the Canadian population, but fewer filled teeth. Conclusions: When compared to the average Canadian population, new refugees to Nova Scotia have poorer oral health as indicated by periodontal and gingival indices. This population also has more decayed and missing teeth, but fewer filled teeth. More research is required to identify barriers to care and strategies to reduce these barriers.

Introduction: In 2016, a report published by the Associated Press, “Medical Benefits of Dental Floss Unproven,” stated that the US federal government no longer supported flossing due to the lack of longitudinal clinical studies. In response, a pilot study by the Dental Hygiene South Texas Oral Health Network (DH-STOHN) was developed to gather data from practising dental hygienists (DH) and dental hygiene educators (DHE) to assess the effects of the AP report on attitudes towards presenting flossing to their clients. Methods: An online survey, formatted with Likerttype dichotomous and open-ended questions, was used to recruit DH and DHE members of DH-STOHN and the Texas Dental Hygiene Association, resulting in a convenience sample of 71 participants. All data were anonymized, aggregated, and analysed for frequency, means, binary outcomes, and thematic narrative. The study was approved as exempt #HSC 20170132E. Results: Respondents were primarily female (97%), non-Hispanic white (73%), age 46 years or older (41%), with more than 20 years’ experience (58%), full-time in practice or educators (each 34%), held associate degrees (48%) of which 74% also held bachelor’s or master’s degree, and were aware of the report (77%), 33% of whom had learned of it from “patients, family, and friends.”. Most (61%) disagreed that there was “no evidence” to support flossing. Many (49%) felt the report’s references were not reliable. Flossing was by far (62%) the least recommended method for interdental cleaning, with dental hygienists stating, “Clinicians ultimately hold the experience and knowledge to exercise the best judgement in the interests of our patients.” Only 41% felt the report changed their discussion about flossing. “I let them know some type of interdental cleaning is still important.” Conclusion: While initial reactions described low levels of confidence in the AP resources, the report enhanced discussions with clients. Dental hygienists are well suited to use their expertise and critical thinking skills to determine individualized oral care techniques for their clients.

Background: While there continues to be dialogue on the level of education required for entry into the profession of dental hygiene, there is a scarcity of literature pertaining to students’ views on the subject. The aim of this study was to explore Canadian dental hygiene students’ views on entry-to-practice dental hygiene education and their future educational aspirations. Methods: In March 2017, an online survey comprising closed- and open-ended questions was conducted with Canadian Dental Hygienists Association student members enrolled in entry-to-practice Canadian dental hygiene programs. Results: Of the 1,738 students who received the survey invitation, 401 students responded (23% response rate). Ninety-one percent of respondents were enrolled in entry-to-practice diploma programs. The majority of respondents agreed that baccalaureate dental hygiene education provides increased knowledge (86%), increased capacity to work with underserved groups (86%), expanded clinical abilities (83%), and enhanced abilities in areas such as critical thinking, research use, and collaboration (85%). Most students (78%) support the vision of all future dental hygienists in Canada having a baccalaureate degree. Approximately 42% of respondents in diploma dental hygiene programs intend to complete baccalaureate education following graduation, 88% of whom intend to enrol in the next 3 years. Reasons for pursuing baccalaureate education include a desire to increase their knowledge base (83%), achieve personal satisfaction (78%), expand career opportunities (75%), increase recognition (75%), increase critical thinking abilities (69%), and access graduate education (58%). Conclusion: These findings provide a new understanding of dental hygiene students’ views and their general support for and interest in baccalaureate dental hygiene education. Such results offer further impetus for discussions about creating additional opportunities for dental hygiene degree education and advancing the entry-to-practice requirements.

Problem statement: In 2015 the Canadian Dental Hygienists Association published the first Canadian Competencies for Baccalaureate Dental Hygiene Programs. To date there is no scientific evidence to support that graduates from baccalaureate programs have gained these abilities. Purpose: To explore the confidence levels of graduating dental hygiene baccalaureate students in their ability to demonstrate the national baccalaureate competencies. Methods: This article examines the preliminary frequency data from the first year of a 3-year longitudinal study involving the graduating students within the University of British Columbia dental hygiene baccalaureate program. An online, anonymous survey was conducted with these students to rate their confidence level based on a 5-point scale ranging from not confident to confident in the national competencies that include 13 domains with 110 associated subcompetencies. Results: Seventeen of the twenty-two graduating students responded to the survey for a 77% response rate. The competency areas in which they expressed the highest confidence were collaboration (100%), clinical therapy (100%), oral health education (90%), disease prevention (86%), professionalism (82%), and integration of knowledge (80%). The areas in which they expressed the least confidence were policy use (20%) and advocacy (11%) where some respondents were not confident, somewhat confident or unsure. Conclusion: These data provide the faculty with important insights to support curriculum revisions, particularly in the policy use and advocacy domains. The data also contribute to a broader national discussion about the baccalaureate competencies and an exploration of the subcompetencies that may be beyond the scope of baccalaureate education.

Objective: This literature review summarizes current research and evidence regarding transgender persons and oral health. Methods: A search of the literature was conducted in the following databases: PubMed, Google Scholar, EBSCO Host, Science Direct, and Wiley Online Library using the keywords “transgender identity, gender non-conforming, discrimination, transition, binary systems, transgender oral cavity, transgender, transgender oral health, transgender dental health.” Articles published from 2000 to 2017 in both peer-reviewed and non-peer reviewed journals, which reported information regarding the oral health status of transgender populations, were selected for review. Results: The search revealed 18 articles, only 7 of which pertained to the oral health status of transgender client populations. Five other articles were eliminated due to either poor quality or irrelevance. Discussion: The 13 articles included in the review revealed a need for oral health care professionals to be aware that gender is not binary, nor is it a mental health disorder. Transgender people face heightened risk of discrimination, violence, anxiety, depression, suicidality, substance abuse, and sexually transmitted diseases, as well as significant barriers to health care of which oral health professionals should be made aware. Conclusions: Transgender people have the same rights as everyone else to oral health care. Oral health care providers are responsible for ensuring that transgender clients receive care that aligns with their needs and for providing that care in a culturally competent manner. This requires an understanding of the basics of gender nonconformance and its impact on oral–systemic health. Additional research is needed to increase the scientific knowledge base to facilitate improved health outcomes for this client population.

Occlusal assessments are often missed or neglected by dentists and dental hygienists. This short communication discusses how these assessments can be implemented through 4 planes of space: anterior–posterior/anteroposterior, vertical, transverse, and perimeter. Expanded occlusal knowledge can improve the referral process for early preventive care. A chairside guide has been defined for dental hygienists to conduct a systematic occlusal exam.

Background: Oral rapid HIV testing (ORHT) is implemented in the dental setting to make individuals aware of their possibly undiagnosed HIV infection. The testing process and characteristics of clients willing to receive ORHT has yet, however, to be systematically collected. Case description: Three dental hygiene clinics located in academic institutions implemented ORHT from March 2016 to April 2017. Results: 231 persons received ORHT; all had non-reactive results. Most had seen a primary care provider in the past year (n = 130), had had a previous ORHT (n = 111), and described themselves as extremely likely or likely to accept a chairside screening in the future (n = 169). The main reason cited for accepting ORHT was that it was free (n = 138). Conclusion: In order to ensure everyone living with HIV is aware of their infection, HIV testing should be expanded into non-traditional settings. The dental setting may help achieve this important public health milestone.

Letter to the Editor

Background: To improve public access to oral health care, dental hygienists have been identified for practice expansion, and, therefore, they must demonstrate decision-making capacity. This study aimed to identify and test potentially influential factors in dental hygiene decision making. Organizational and gender factors were hypothesized to be most influential and focused the study. Methods: A 2-phase mixed methods approach was used. In Phase I, a qualitative decision-making model was developed and subsequently published in 2012. Phase II tested aspects of the model through an electronic survey instrument and key informant interviews. This article reports on the statistical results of the quantitative survey. A third article will report on the qualitative thematic analyses and merged interpretation. Results: The Phase I qualitative model guided the development of the survey instrument. The survey had a 38% response rate; moderate to weak correlations between predictor variables (structural and individual) and clinical decision making were shown. The final statistical model demonstrated that individual characteristics and graduating from a 3-year dental hygiene program were together significantly associated with decision-making capacity. Discussion and Conclusions: Individual characteristics and longer education were together shown to be associated with increased decisionmaking capacity. These findings did not show the organization or gender to be important in influencing decision-making capacity. However, the merging of the quantitative survey and qualitative key informant data will potentially inform how the organization influences the individual dental hygienist.

Background: Research shows that immigrants have higher rates of oral diseases, poorer access to dental care services, and lower levels of health literacy than their Canadian-born peers. Oral health literacy has emerged as a potential pathway to reduce oral health disparities. The scarcity of studies on oral health literacy interventions, particularly among immigrants, lent urgency to this study, the purpose of which was to evaluate the effectiveness of an oral health literacy intervention promoting oral hygiene self-care behaviour among Punjabi immigrants. Methods: The study used a parallel group, non-blinded, randomized controlled trial design. One hundred and forty (140) Punjabi immigrants between 18 and 60 years of age were enrolled. Participants were randomly allocated to receive either the Safeguard Your Smile (SYS) intervention or a conventional pamphlet. The following outcome measures were assessed at baseline and 3 months post-intervention: self-reported oral hygiene self-care behaviour and knowledge, plaque and gingival indices, and oral health literacy. A linear mixed model for repeated measures was used to compare the intervention and control groups (between) at pre- and post-intervention (within). Results: Participants who received the SYS intervention showed improvements (p < 0.0001) for the following dependent variables: oral hygiene self-care knowledge and behaviour, oral health literacy, and plaque and gingival indices. Conclusions: SYS intervention enhanced positive oral hygiene self-care behaviour among Punjabi immigrants with low oral health literacy. SYS intervention can be employed among other vulnerable groups with low levels of oral health literacy to improve oral hygiene self-care behaviour.

Background: The Canadian Dental Association and Canadian Dental Hygienists Association recommend that a child’s first dental visit should occur no later than 1 year of age. However, this recommendation has not been strongly supported by the dental community. The purpose of this study was to explore factors influencing the provision of infant–toddler dental homes from providers’ perspectives. Understanding facilitating factors is integral to developing strategies to improve infant–toddler oral health care. Methods: This study employed a qualitative interpretive descriptive methodology, using semi-structured interviews with a purposive sample of 13 dentists and dental hygienists who routinely provide dental homes for the infant–toddler cohort. The constant comparative method was used to support thematic analysis. Results: Thematic analysis revealed factors that were both endogenous and exogenous to the practitioner. They were categorized into 4 interrelated themes: 1) practitioner; 2) practice; 3) profession; and 4) population. Together these 4 themes form a model of the 4 Ps that influence provision of infant–toddler dental homes. Common endogenous factors include the practitioner’s comfort with young children and having clinical exposure to pediatric clients during dental education. Common exogenous factors include parental awareness and adequate insurance coverage for preventive procedures. Strategies to improve acceptance of infant–toddler dental homes include enhanced practitioner education and public awareness, consistent messaging from the dental community, as well as increased remuneration for preventive pediatric oral health care. Conclusion: Provision of infant–toddler dental homes is affected by multifaceted variables. Consequently, strategies to improve uptake must employ a multipronged approach.

Background: Dental hygiene programs must ensure students are competent and confident to meet the oral health needs of pediatric clients. The purpose of this pilot study was to evaluate dental hygiene students’ perceived self-confidence to perform dental hygiene services and manage client behaviour. Methods: The study was deemed exempt by the institutional review board. A mixed methods approach evaluated 36 first-year dental hygiene students’ perceived self-confidence using an electronically delivered valid survey that consisted of 19 questions on a 5-point Likert scale (1 = not at all confident to 5 = totally confident) and 1 reflective question. Results: The response rate for the survey was 100% (N = 36). Over 60% reported “totally confident” when completing a medical history; formulating and communicating a treatment plan; providing oral hygiene instruction; and applying fluoride varnish. Only 11% (n = 4) reported “totally confident” in exposing radiographs on pediatric clients. Roughly 42% (n = 15) reported “reasonably confident” and 28% (n = 10) reported “totally confident” when managing behaviour throughout the appointment. The multiple regression model explained 64% of the variance and was a significant predictor of managing behaviour, F (6, 29) = 8.70, p = 0.000. Reflective responses suggest that clients’ age, appointment length, and dental procedures posed behaviour management challenges. Discussion: The majority of students reported “reasonably” or “totally” confident when performing dental hygiene services. However, more clinical opportunities are warranted to increase self-confidence in managing pediatric clients’ behaviour. Conclusions: A review of pediatric client content and experiences within dental hygiene programs is suggested to ensure graduates are prepared to meet pediatric needs.

Objective: To determine the potential value of YouTube videos as health decision aids for the public. Methods: An integrative review was performed to explore 3 questions: 1) What is the validity of health-related YouTube videos created for the public? 2) Are YouTube videos an effective tool for supporting the public in decision making regarding the treatment, prevention, and diagnosis of disease? 3) How can health professionals ensure their videos will be readily accessible to those searching online for health-related information? Systematic searches of PubMed, CINAHL, and Web of Science were conducted. The returns were screened using inclusion and exclusion criteria and studies found were critically appraised. Results: Fifty-eight studies assessed the validity of videos on given topics and 9 studies examined the effectiveness of videos in supporting decision making. These studies demonstrated that the majority of health-related YouTube videos lack validity. However, evidence-based videos do exist and have the potential to be an effective instrument in supporting the public in making health decisions. Ten studies examined ways to increase the accessibility of such videos to the public. Discussion: Creators of evidence-based videos must take into consideration content and content-agnostic factors to improve the accessibility of their videos to searchers. Recommendations to support creators in making their evidence-based health videos readily accessible to the public are provided. Conclusions: By exploiting appropriate content and content-agnostic factors, video creators can ensure that valid health information is readily accessible to information seekers.

Multiple supernumerary teeth are one of the most common developmental anomalies in humans. They could be associated with prolonged retention of deciduous teeth, displacement or rotation of the adjacent teeth, crowding, aberrations in the root morphology (dilacerations), and failure in eruption or impaction of the succedaneous teeth. This article highlights 2 cases of non-syndromic mandibular twin supernumerary teeth in young female clients with a chief complaint of spacing between the teeth and over-retained deciduous teeth. A diligent clinical and radiographic monitoring is warranted considering the early innocuous effects and delayed adverse effects of this condition.

ABSTRACT Background: This study evaluated the perceived benefits of using professional and volunteer language interpreters with diverse health care backgrounds in an immigrant dental hygiene clinic where the majority of clients have limited English proficiency. Methods: An original survey was distributed to dental hygiene students (N = 26), faculty (N = 9), and interpreters (N = 35) involved in the immigrant clinic between September 2016 and April 2017. Closed-ended questions were summarized using descriptive statistics. Open-ended questions were examined for common themes. This project was approved by the Research Ethics Board (REB # 2016-4076). Results: Response rates were as follows: dental hygiene students (84.6%), faculty supervisors (77.8%), professional interpreters (100%), and volunteer interpreters (24.2%). All faculty (100%) and 95% of students reported working with interpreters, all of whom had backgrounds in health care; 84.6% of faculty and 71.4% of students preferred to collaborate with untrained volunteer interpreters, specifically, those who were dental students. Both untrained volunteer and professional interpreters felt they aided in the treatment of clients in a culturally competent manner and their assistance was an overall benefit to both the student and client. Faculty (85.7%) and students (66.7%) reported they would not feel comfortable treating an immigrant client with limited English proficiency without an interpreter. Conclusions: This study revealed that interpreters with various health care backgrounds are useful in an immigrant dental hygiene clinic. The untrained volunteer interpreters with dental backgrounds were preferred over professionally trained interpreters.

Background: Critical thinking is a high-level cognitive function desired in graduates of higher education, including professional education programs such as dental hygiene. Research has examined best practices in nurturing critical thinking in adult education and professional education. Yet research specific to critical thinking in dental hygiene education is limited, let alone research that aligns dental hygiene educational strategies with the development of critical thinking. Methods: This exploratory qualitative study is designed to deepen understanding of dental hygiene students’ perceptions and experiences of acquiring critical thinking skills during their professional education. Data were gathered during a focus group session followed by individual interviews of 7 recent graduates of a community college-based dental hygiene program in Ontario, Canada. Inductive data analysis was performed using an interpretive perspective. Results: Participants indicated their critical thinking began with acquiring base knowledge of theory related to the field of dental hygiene followed by the development of a thought process using case scenarios with small group work and discussion. The clinical setting was noted as a real and challenging environment in which to apply critical thinking. Participants valued being offered a variety of activities aimed at developing their critical thinking. Conclusion: Many of the findings of this exploratory study align with research on developing critical thinking in adult education and professional education. This qualitative study provides beneficial preliminary information about how dental hygiene students develop critical thinking.

Background: Oral health inequalities persist in Canada; those with the greatest oral health needs have the greatest difficulty accessing care. With the closure of the only dental therapy program in 2011, access to restorative and surgical oral health services has decreased. Objective: To explore how dental therapy abilities might best be integrated into Canadian postsecondary oral health education. Methods: Purposeful sampling was used to invite key informants from Canadian underserved populations, government, educational administrators, and educators as well as international educators and administrators for a semi-structured interview. The overall response rate was 74% (n = 53). Thematic analysis was used to code the data, identify similarities and discrepancies, and generate themes. Results: Respondents provided input on educational models and emphasized the following essential elements that need to be in place for any educational model to be viable and sustainable: innovative workforce delivery models, remuneration models for cost-effectiveness, supportive regulatory parameters, sustainable oral health programs and initiatives for underserved groups, employment opportunities for graduates, and increased management of policy interferences and professional tensions. Conclusion: There was unanimous support for the re-establishment of educational models incorporating dental therapy competencies. While an educational model was considered necessary, it was not viewed as sufficient for the re-establishment of dental therapy abilities within Canadian postsecondary education. The above essential elements were described as critical for any educational model to be viable and sustainable. Bringing these essential elements together requires the support of health professionals, educators, regulators, and governments.

Background: This study reviews the literature on the short- and long-term effectiveness, safety, and acceptance of silver diamine fluoride (SDF) therapy for children and adults with carious lesions and/or dentinal hypersensitivity as it applies to dental hygiene practice. Methods: Using the scoping review methodology by Levac (2010), the authors retrieved 662 records from 7 electronic databases, 3 clinical trial registries, and Google. Thirty-eight publications met the following inclusion criteria: clinical application of SDF on human subjects; published in English between 2000 and 2017. Results were synthesized under categories defined by the principles of a health technology assessment. Results: Data regarding clinical and prospective trials of SDF were available for 3 indications: arresting carious lesions (age range: 3 to 8 years), arresting root carious lesions (age range: 65 to 85 years), and reducing dentinal hypersensitivity (age range: 43 to 44 years). The longest follow-up period was 36 months. Adverse events and parent/caregiver acceptance were reported in most studies. Discussion: A broad range of evidence on the effectiveness, safety, and acceptance suggests that SDF could be used within the dental hygiene armamentarium. Current evidence and guidelines support the use of SDF for arresting carious lesions in primary dentition, but there is limited evidence for the use of SDF to arrest root caries or reduce dentinal hypersensitivity. Gaps in research on training requirements, treatment protocols, and long-term effectiveness and safety were also identified. Conclusion: Evidence suggests that SDF could be an effective and safe therapy to add to the dental hygiene clinical armamentarium for the management and arrest of coronal caries in primary dentition, with further research required to support its use for other clinical applications.

Background: The Aboriginal population in Canada experiences significant health disparities due to the enduring traumas of colonization. While oral health also suffers as a result of social inequities, there is limited knowledge of the factors influencing oral health care experiences as current research focuses on early childhood caries and accessing general health services. Objective: This review aims to identify the factors affecting Aboriginal peoples’ attitudes towards and experiences in accessing oral health services in Canada in an attempt to contribute to the discussion of how oral health professionals can better support this population’s oral health. Discussion: Major influencing factors include racism, culture, access to health information, and the approach of the health care provider. Past experiences result in a fear of encountering racism in health care settings and the internalizing of socially constructed prejudices. Culturally based health beliefs contribute to a desire to receive services from an Aboriginal practitioner and indicate a need for culturally safe care. Challenges in navigating the health care system include a lack of transportation, language differences, literacy, and knowledge. The approach of the health care provider greatly shapes health care experiences and influences health outcomes. Conclusion: There is a need for research focusing specifically on the Aboriginal population’s experiences in and attitudes towards accessing dental services. Oral health providers should adopt a holistic approach to care by deconstructing social norms and considering this population’s unique social and economic challenges. Practitioner–client interaction is crucial in developing a trusting relationship that will improve oral health care experiences.

Background: The 4 main chronic diseases causing death worldwide are cardiovascular disease, diabetes, cancer, and respiratory disease, and there is strong evidence demonstrating an association between oral conditions and each of these diseases. Unlike previous generations, baby boomers are keeping their own natural teeth as they age. Given this fact, older adults need to be aware of oral-systemic associations and must possess appropriate literacy and knowledge skills to support healthy aging. Purpose: This preliminary, descriptive study explored baby boomers’ levels of oral health literacy and oral health knowledge about the association between oral health and common chronic diseases. Methods: This study collected both qualitative and quantitative data using questionnaires delivered over the internet. The questions consisted of fixed responses and open-ended items. This study received ethics approval from the University of Prince Edward Island Research Ethics Board. Results: A total of 69 community dwelling participants (19 males; 50 females) ages 50 to 69 years participated in the study. Oral health literacy and oral health knowledge scores were calculated for the total sample and within distinct age groups. A Pearson product-moment correlation coefficient was used to determine relationships between the 2 independent variables: 1) oral health literacy and 2) oral health knowledge. The results indicated a low but positive correlation between oral health literacy and oral health knowledge scores (r = 0.31, n =69, p = 0.008). Conclusion: While participants had adequate oral health literacy scores, many lacked knowledge of the association between oral diseases and common chronic diseases. Dental hygienists can play an integral part in educating aging clients to help them improve their knowledge of this association. Due to the small and relatively homogenous sample recruited, it is not possible to generalize the results to all Canadian baby boomers. Additional studies with more diverse participants are required to further explore the association between oral health literacy and oral health knowledge.

Background: As part of a broader research program on community water fluoridation (CWF) cessation and implications for dental health outcomes, this study explored whether dental hygienists working in communities where CWF had ceased reported having engaged in practice adaptations, as compared to dental hygienists working where CWF remained in place. Methods: All Alberta dental hygienists were invited to complete an online questionnaire about changes to their practice of dental hygiene since CWF cessation (e.g., in-office fluoride treatment recommendations, oral hygiene education) or, for those in still-fluoridated communities, during a similar timeframe. Reported practice adaptions between the 2 groups were compared using chi-squared analysis. Results: A total of 154 dental hygienists provided information on practice adaptations. Those working in fluoridation-cessation communities (62%) versus still-fluoridated communities (38%) were 1) more likely to report increasing their recommendations to clients for more frequent in-office fluoride; and 2) less likely to report decreasing their recommendations to clients for more frequent radiographs (x-rays) to detect decay, based on differences at the 5% significance level. However, the 95% confidence intervals were overlapping, suggesting that the effects were not robust. There were no differences between the 2 groups in attitudes towards fluoridation, a potential confounder. Discussion and conclusions: Research on CWF cessation and implications for population oral health is complex and must consider factors aside from fluoridation cessation that may change during the same period. Dental hygiene practice may be one important factor, and further research on the role of dental hygienists in assessing and adapting to changing caries risk in CWF cessation circumstances is warranted.

Purpose: The purpose of this study was twofold: first, to elevate the importance of oral health-related quality of life (OHRQoL) in the minds of oral health care providers involved in this project; and second, to evaluate the experience of those providers in administering the Pediatric Oral Quality of Life (POQL) instrument and propose strategies for implementation based on lessons learned. Methods: A workshop was conducted in summer 2016 during which participants were informed of their role in the project including the collection of OHRQoL data. At the end of the workshop attendees completed an evaluation stating that they agreed or strongly agreed that they had a good understanding of OHRQoL and felt competent to administer the POQL chairside. The oral health care workers administered the POQL to children and parents or guardians in fall 2016. A 17-item questionnaire designed to investigate how they felt about utilizing the POQL in practice was administered. Results: Twelve of nineteen practitioners (63%) provided full responses. Half were dental hygienists, 3 were dental assistants, 2 were office administrators, and 1 was a dentist. The majority reported full-time employment and had worked in their organization for 2 to 3 years. All child POQLs were completed chairside at various times during the appointment. Administration of the POQL took on average 6 minutes with most children receptive although not always sure why they were being asked how they felt about their teeth and mouth. Parents and guardians raised no objections to filling out the POQL or having their child do so. Oral health care workers reported the POQL provided greater insight into the child and his or her oral health. Challenges included the need to explain or rephrase questions, fitting the POQL instrument into the workflow, and time. Conclusion: Training and implementation of the POQL instrument introduced the concept of OHRQoL measures as a part of data collection in dentistry. The oral health care worker responses and comments on the 17-item questionnaire show an elevated awareness of OHRQoL as a result of participating in this project. These early results indicate that implementing an OHRQoL measure in practice requires little time while providing a more complete picture of the impact of a child’s oral condition on their quality of life.

Background: A growing body of research demonstrates the degree to which dental hygienists cite barriers to the provision of clinical therapy. Many of these barriers appear to be associated with challenges experienced in entry-to-practice clinical education. This review explores the intersection between clinical dental hygiene education and perceived barriers to the provision of effective clinical therapy. Methods: Fifty full-text journal articles and eight graduate theses retrieved from PubMed, Education Source, SAGE Journals, EMBASE, and the Cochrane Library databases were reviewed and thematically analysed. Results/Discussion: Emergent themes revealed inconsistencies in dental hygienists’ provision of clinical responsibilities; students’ perceptions of calibration discrepancies in clinical dental hygiene education; clinical stressors influencing students’ development of clinical skills; challenges in andragogic preparation; difficulty in recruiting qualified clinical educators; and challenges in students’ transition to professional practice. Findings indicate time limitations, confidence, a desire for additional education, and a perceived lack of dentist support were leading barriers to dental hygienists’ provision of clinical therapy. Dental hygiene students reported receiving inconsistent feedback from clinical educators and expressed a desire for greater clinical supervision and calibration. Clinical educators reported a desire for greater calibration efforts, faculty support, and andragogic preparation. Conclusion: A review of the literature demonstrates an association between the barriers cited to the implementation of clinical dental hygiene services in professional practice and challenges experienced within clinical dental hygiene curricula.

Clients may be at risk for medical emergencies during oral health care treatment, be it invasive or noninvasive. Stress has often been identified as a trigger for medical emergencies, thus employment of stress reduction strategies has been suggested to prevent such events from occurring, particularly in apprehensive and medically compromised clients. Although oral health professionals are trained to categorize the psychological nature of an individual and his or her expected response to treatment procedures, actual behaviour is difficult to predict. One of the procedures clients often find stressful in dentistry is the injection of local anesthetic prior to commencement of a procedure. One stress reduction strategy suggested in the literature is the use of “eupnea” or deep breathing, although not typically employed routinely by oral health professionals. This short communication aims to illustrate the beneficial effects of eupnea and suggests that it may be useful for clients who find the injection of local anesthetics to be stressful. Eupnea could potentially minimize the incidence of medical emergencies in the oral health care setting.

Edited by Irving Rootman, Ann Pederson, Katherine L Frohlich, and Sophie Dupéré Toronto: Canadian Scholars; 2017. 498 pp. with index ISBN 978-1-77338-006-3; available from Canadian Scholars (www.canadianscholars.ca/books/health-promotion-in-canada-4th-edition)

The planning of a joint conference between 2 separate organizations in 2 different countries is not an easy task. The birth of this idea took place 3 years ago at the 3rd North American/Global Dental Hygiene Research Conference held in Bethesda, Maryland, by the National Center for Dental Hygiene Research & Practice (NCDHRP). A meeting between the Canadian Dental Hygienists Association (CDHA) Research Advisory Committee and the NCDHRP Advisory Committee during that conference led to the decision to cohost an international meeting in Ottawa in October 2017 during Canada’s 150th birthday celebrations. What they didn’t realize at the time was how much of a success this conference, Translating Knowledge to Action, would actually be and that attendance would be “maxed out” with just over 500 participants. This was indeed a record for both groups! The international presence was not just from Canada and the United States; representatives from 14 other countries were in attendance! There were 60 poster presentations and 29 oral presentations informing attendees of the latest dental hygiene research findings. One of the goals of our profession for almost 50 years has been to increase the research base specifically as it relates to dental hygiene knowledge in order to be truly considered “a profession.” One of the primary caveats of a true profession is to have a body of knowledge that is unique to the profession. We believe this conference has indeed helped to add to our body of knowledge. Not only did this conference highlight the latest research findings for attendees, but it also provided an opportunity for collaboration and networking with international colleagues. The dental hygiene profession globally is relatively small in comparison to most other health professions such as nursing and physiotherapy and, as such, this conference brought together colleagues from around the world. Attendees from Canada, the United States, United Kingdom, Japan, Australia, Italy, Portugal, The Netherlands, and many other countries were seen mingling and networking in the cozy restaurant area of the conference facility. The richness of such an experience raised an awareness of how similar dental hygienists are around the world, yet also allowed everyone to explore the differences in their professional practices. We all belong to the same community and we believe this conference brought us much closer together. As dental hygiene journal editors representing both Canada and the US, we had the privilege of working together on a conference presentation about manuscript preparation and submission, and were both so impressed with the 100% attendance as well as the calibre and mix of attendees who were truly interested in dental hygiene research and publication. We believe the collaboration and learning experiences gleaned from this conference are just the “tip of the iceberg” and should be the beginning of many more opportunities to network and learn from each other. We hope you will take the time to read the numerous and diverse conference abstracts published simultaneously in the *Canadian Journal of Dental Hygiene* and the *Journal of Dental Hygiene* whether you attended the conference or not. At conferences as diverse as this one, it is impossible for attendees to see all of the presentations and to visit all of the posters. Enjoy the reading!

**Objective:** Thorough debridement is the basis of periodontal treatment and a profound segment of dental hygiene expertise. Studies indicate Canadian dental hygiene graduates use ultrasonics with an outdated (traditional) approach resulting in an “unconsciously incompetent” clinician. This study tests a revised ultrasonic curriculum aimed at producing a more “consciously competent” graduate. **Methods:** This convenience sample study measured ultrasonic process and outcomes for graduates of an accredited Canadian school before (n = 17) and after (n = 18) implementation of a novel ultrasonic curriculum with enriched ultrasonic theory, preclinic and clinic content. Graduates were evaluated “in process” using a validated indexed rubric on 4 foci: equipment preparation, infection control, positioning, and instrumentation technique. Post-scaling, teeth were removed from the identical typodonts, anonymized, and scored for “outcomes” using tested grid calculations for 3 types of standardized deposits: heavy/ tenacious, light, and biofilm. Ethics approval was obtained from Niagara College, Ontario. **Results:** From a potential 510 points for in process skills, the baseline graduates achieved a mean score of 112.3 compared to 295.6 for the enhanced curriculum cohort. The baseline group left 10.5 grids of tenacious calculus, 23.3 grids of light calculus, and 60.18 grids of biofilm from a potential of 72 each when outcomes were measured. In contrast, the enhanced curriculum cohort left 4.1, 7.4, and 39.3 grids, respectively. A 2-tailed, unpaired t-test measured statistical significance. All p values show statistical significance between the mean scores at the 0.01 level. **Conclusions:** The enhanced curriculum produced graduates with process improved by 263.1% (p < 0.0001). Debridement outcomes were enhanced similarly. This study suggests that an enriched ultrasonic curriculum can be inserted into an existing dental hygiene program with vastly improved results.

**Objectives:** The aim of this analysis was to investigate whether twice-daily use of a rotating–oscillating power toothbrush (Oral-B Professional Care 1000™) in nursing home (NH) residents over a 6-week period, compared to usual care, would reduce systemic inflammation as measured by C-reactive protein levels. **Methods:** A repeated measures single-blind randomized controlled trial was conducted with residents from 1 nursing home in Winnipeg, Canada, who were randomized to receive either twice-daily toothbrushing with a rotating–oscillating power toothbrush (PB) or usual care (UC) by caregivers. Consent was obtained from residents or their proxies. Participants had some natural teeth; periodontal inflammation; non-aggressive behaviour; no communicable diseases; were non-smokers; and non-comatose. This article reports on a secondary outcome of this trial that measured the systemic inflammation of participants at baseline and 6 weeks, using a high sensitivity C-reactive protein (hsCRP) assay. Changes in hsCRP were not normally distributed, thus data were analysed using non-parametric methods. Within group changes were measured with the Wilcoxon Signed-Rank Test and between group comparisons of ranked differences employed the Kruskal–Wallis Test. **Results:** Of 54 participants, 3 died before study completion leaving n = 51. No significant differences in CRP values were found between study groups (X2(1) = 0.191, p = 0.662) with a mean rank score of 27.88 for the PB group and 26.02 for the UC group. **Conclusions:** Twice-daily power toothbrushing of NH residents’ teeth did not significantly reduce levels of systemic inflammation as measured by hsCRP.

Granuloma gravidarum, commonly known as “pyogenic granuloma,” is a reactive inflammatory hyperplasia that occurs in response to various stimuli such as low-grade local irritation or trauma, hormonal factors or certain kinds of drugs. Occasionally it develops during pregnancy because of the hyperresponsiveness of the oral tissues to increased levels of pregnancy hormones. This case study describes a persistent pregnancy tumour postpartum and discusses its management using electrocautery. Simple oral hygiene measures are highly effective in preventing both the initial occurrence and persistence of such lesions postpartum. Pregnant clients should be educated about the risk for developing pyogenic granulomas and counselled on the importance of maintaining good oral hygiene.

**Problem statement:** Since 1945, the entry-to-practice requirement for dental hygiene has remained at a 2-year level. Dental hygiene lags far behind other health professions in acknowledging the education required and provided to meet today’s advanced scope of practice and the clinical responsibilities required within the dental hygiene process of care. Purpose: The majority of dental hygienists complete more than 2 years of college for an associate degree. The purpose of this study was to determine if a 2-year associate degree appropriately represents the current level of dental hygiene education. **Methods:** This is a retrospective, analytical pilot study comparing 3 current community college dental hygiene programs to the 1945 standards for 2-year dental hygiene programs. Additionally, the curricula of these community college dental hygiene programs and 1 university program were compared for contact credit hours required, credits earned, credits granted, and degrees conferred. **Results:** Descriptive statistics revealed that community college graduates today complete 112 earned credits compared to 61 credits in 1945, a difference of 51 credits. Today’s university dental hygiene program requires 13 contact credit hours more than the community college programs, 7 more earned credits, and grants 16 more credits for the BS degree than are granted for an AAS degree. These differences do not exceed one semester of additional course work for associate degree graduates to achieve a BS degree. This pilot study is limited by the small sample size of dental hygiene programs included for analysis. Further studies need to include a broader array of dental hygiene programs. **Conclusion:** Dental hygiene education has expanded significantly since 1945, without the requisite degree being granted.

**Problem statement:** Increasingly more online courses are offered in higher education. A commonly identified problem with online courses is that students lack a feeling of connectedness and sense of community when taking online courses. **Purpose:** The purpose of this study was to examine the use of a text messaging application in online dental hygiene courses. The study utilized data analytics, student preferences, and Community of Inquiry (COI) measures to explore the utilization of a text messaging application in online dental hygiene courses. **Methods:** Institutional review board approval was obtained. A text messaging application was implemented into a BS course and a MDH course. Students in 3 online dental hygiene courses were given instructions and access to a text messaging application. At the end of the semester, the students filled out a satisfaction and COI survey. Data analytics were also collected from the messaging application software. **Results:** A total of 31students completed the study. Most students were 20 to 25 years of age, female, and in an entry-level baccalaureate program. Thirty percent of students reported using the application very frequently and 30% reported using it occasionally. Seventy-one percent of students agreed or strongly agreed that receiving notifications on their phone was a good way to communicate course information. Students also noted that their course instructor answered messages faster on the application than via email. The COI survey revealed moderate to high levels of teaching (3.0±1.0), social (3.0±0.68), and cognitive (3.0±0.73) presence. Graduate students reported significantly higher COI than entry-level students (p = 0.001). **Conclusions:** Most students reported a messaging application to be useful, efficient, and helpful in facilitating information about their online course. Students who have no face-to-face classes reported higher COI than those students who attended courses face to face.

**Problem statement:** A recent study used the Scale of Positive Well Being, the Adult Hope Scale, and the Values Questionnaire in conjunction with the widely used Dental Environment Stress questionnaire to explore stress and well-being in a combined program of dental hygiene and dental therapy students (DHDTS). The findings of this research showed that students reported high scores of psychological well-being at the same time as high sources of stress, and provided baseline data for this qualitative follow-on study. **Purpose:** To use a qualitative approach to further explore the stress and well-being of DHDTS during their undergraduate training. **Methods:** Ethical approval was obtained from the University of Portsmouth Science Faculty Ethics Committee. A purposeful selection of 8 DHDTS from the University of Portsmouth Dental Academy (11% of total student population) were recruited to participate in semistructured recorded interviews of approximately 45 minutes duration. A piloted interview schedule designed to explore perceived motivation, goals (in particular, goal failure), and stress in DHDTS was used. Thematic analysis of all data was undertaken by the first author, using Braun and Clarke’s (2006) 6 phases of thematic analysis. Twenty-five percent of the data were analysed independently by the 2 second authors experienced in qualitative methodology. **Results:** Three main themes of “fulfillment,” “the learning environment,” and ”perception of stress” were identified. Within these themes, 12 subthemes were identified. Analysis suggested that a strong sense of passion to become a clinician mitigated most, but not all, of the stressful experiences of the DHDTS undergraduate learning environment. **Conclusions:** Fulfillment from the learning environment meant that DHDTS perceived sources of stress (positive and negative) during their undergraduate programme were strongly linked to a sense of meaningfulness.

**Problem statement:** Student well-being can have significant impact not only on their overall health, but also on their learning experience and the quality of patient care they deliver. While stress is an inevitable part of the university experience, previous work has shown that students in the health care professions have higher levels of stress than their non-health care counterparts. **Purpose:** This work examines whether dental hygiene (DH) students have a different wellness experience than other postsecondary students. **Methods:** The Research Ethics Board at the University of Alberta approved this work. DH students admitted in 2015 and 2016 (N = 80) were invited to complete the National College Health Assessment (NCHA), a survey that examines the health and wellness of university students, in February 2016. The results were compared with the spring 2016 NCHA Canadian Reference Group which consisted of 43,780 responses from students attending 41 postsecondary institutions in Canada. **Results:** A total of 48 DH students (60%) responded to the NCHA. DH students were more likely to report that anxiety (41.7% vs 32.5%), sleep difficulties (35.4% vs 28.4%), and stress (68.8% vs 42.4%) were affecting their academic performance when compared with the Canadian Reference Group. Similarly, DH students were more likely to report feelings of hopelessness (68.8% vs 59.6%), being overwhelmed (97.9% vs 89.5%), exhaustion (97.9% vs 88.2%), and loneliness (70.8% vs 66.6%) in the last 12 months. **Conclusions:** DH students report a higher incidence of mental health stressors than the Canadian postsecondary student population and they believe these challenges impact their academic performance. Baseline measures of DH student health and wellbeing will allow educators to design curricula and health initiatives aimed at promoting self-care and well-being.

**Problem statement:** Many health care professions rely on a preliminary diagnosis, which is later confirmed or refuted by a definitive diagnosis. In dental hygiene, a dental hygiene diagnosis (DHDx) is formulated based on the assessment phase of care. There is currently no research available to show how the concept of the DHDx is utilized in dental hygiene education programs. **Purpose:** The purpose of this study was to investigate how dental hygiene educational programs incorporate DHDx into current dental hygiene curriculum. **Methods:** An exploratory, descriptive study was designed to assess the extent to which DHDx is integrated into entry level dental hygiene curriculum. A 30-item self-generated survey was designed and content validity established using a subset of dental hygiene faculty and researchers as well as participant team members from the American Dental Hygienists’ Association. Human Subjects Committee approval was received from Idaho State University. Data were collected using the online survey tool Qualtrics®; 2 mailings were sent. All surveys included a consent form and confidentiality was maintained. Descriptive statistics were utilized to analyse data. **Results:** Of the 334 surveys sent, 198 responses were received for a response rate of 59%. Of the responding programs, 98% reported that the dental hygiene process of care and concepts specifically relating to the DHDx were taught in the program. In addition, 79% of programs confirmed they “always” require students to write a DHDx statement for the patients. Of the respondents, 80% recognized that formulating a DHDx would result in improved patient outcomes, and 76% indicated that a DHDx increases the dental hygienist’s accountability in patient care. Over 50 individuals provided comments indicating the need for standardization and faculty calibration for DHDx terminology, and that conflict exists surrounding this topic. **Conclusion:** It appears that DHDx is an integral component of entry-level dental hygiene education.

**Problem statement:** The Entry-to-Practice Competencies and Standards for Canadian Dental Hygienists (National Competencies) document was published in January 2010 by the dental hygiene governing bodies and were provided nationally to dental hygiene schools for implementation in the curriculum. However, the current hierarchal structure of dental hygiene education gives dental hygiene educators little opportunity to voice their experiences during a reform that requires them to build new personal capacity to implement the national competencies. **Purpose:** The purpose of this interpretive, qualitative study was to explore Ontario dental hygiene educators’ perceptions of how they could build personal capacity during the national competencies curriculum reform. **Methods:** This qualitative study used a purposive sample of 5 dental hygiene educators of diverse training and teaching organizations who participated in in-person interviews, 1 participant via telephone interview, and 1 participant through Skype interview. A semistructured interview guide framed open-ended data collection. Recorded narratives were transcribed and analysed, coded, and interpreted using within-case and cross-case thematic analysis. Findings were validated through member checking and triangulation of data. This study received approval from the Brock University Research Ethics Board. **Results:** Themes drawn from the data demonstrated that perceptions of collegial identity for all members of the dental hygiene profession are required for building personal capacity. Participants observed that discussions and conversations as educators and as a profession need to occur. They also indicated that standardizing dental hygiene education at the degree level on a national basis and collaboration and communication among educators could establish consistent dental hygienists’ identity. **Conclusions:** Despite the literature describing the national competencies as establishing professional identity, participants described the need for further discussions among educators to build a solid foundation. As the data demonstrate, the building of personal capacity will require the establishment of a more open and collaborative system. Funding for this project was provided by Canadian Institutes of Health Research and Canadian Foundation for Dental Hygiene Research and Education.

**Problem statement:** Community-dwelling individuals living with dementia (ILDs) progressively struggle to perform self-care activities such as daily oral hygiene, and increasingly require support. Care partners’ (CPs) experiences and strategies for supporting oral hygiene are unknown. **Purpose:** To examine CPs experiences and practices of supporting daily oral hygiene activities of ILDs. **Methods:** Qualitative exploratory design using focus groups. Twenty CPs, either ILD spouses or a child, were recruited through the Alzheimer’s Society. In 5 semistructured focus groups, participants explored their experiences, practices, and strategies in supporting oral hygiene activities of ILDs. Saturation was reached when no new data emerged. Data analysis consisted of content analysis, including open coding, categorization, and abstraction. How individuals expressed their practices, and the synergistic effect between participants that allowed participants to realize new insights about their current practices were also analysed. **Results:** While dementia severity is assessed clinically, there was little correspondence with ILDs’ reported level of independence. Oral hygiene practices reflected a continuum of independence ranging from wholly or partially independent to wholly compensatory. CPs contextualized oral hygiene as one dimension of preserving the autonomy of ILDs. Strategies to support oral hygiene included relying on embodied habits, providing supportive aids, verbal reminders, and physical intervention. Difficulties occurred when the ILDs resisted support or could not alter engrained habits. CPs understood that strategies had to change over time, although some realized, during the focus group sessions, their practices were insufficient to meet the current needs of ILDs. Ethics approval was obtained from the University of Alberta Research Ethics Board (Pro00060323). **Conclusion:** CPs struggled to identify key transition points, indicating the need for a different level of assistance as oral hygiene was assumed to be an embodied and persistent habit. Accurately determining an ILD’s actual abilities as well as strategies to gain the ILD’s cooperation is needed.

**Problem statement:** Poor oral health in long-term care (LTC) has been well documented, yet how oral health recommendations are being managed by facility staff and how referrals to dental professionals are processed is less well understood. **Purpose:** The purpose of this study was to examine how oral health recommendations made by a registered dental hygienist (RDH) for seniors are managed by facility staff and how referrals to dental professionals are processed. **Methods:** Ethics approval was obtained from the University of Alberta Research Ethics Board (#Pro00060584). First, a retrospective chart review was conducted to obtain data from oral assessments completed by dental hygiene students with supervision of a registered dental hygienist at 4 LTC sites. Second, semistructured interviews were conducted with a convenience sample of 4 health care providers, 1 from each site, and each was selected based on his or her role as a “champion” of oral care at their facility. Three registered nurses and one dietician were interviewed. Interview questions explored how recommendations and referrals for oral care were managed by staff. Interview data were analysed using content analysis. **Results:** Data were collected from 317 charts. Recommendations for oral care were made for 241 residents (76%); 165 residents (52%) were given recommendations such as needs assistance or cueing to perform daily toothbrushing; 125 external referrals were made, 56 to dental hygienists, 58 to dentists, 10 to denturists, and 1 to other. Interview data revealed families are predominantly responsible for organizing dental appointments for the resident. Finances, level of cognition, resistive behaviours, family member support, staff turnover, and time, are reported by staff to be barriers to ensuring seniors in facilities visit a dental professional when indicated. **Conclusions:** Multiple factors affect implementing recommendations and pursuing dental referrals for residents of LTC; therefore, a multipronged approach is necessary to overcome barriers, ensuring seniors receive recommended oral care.

**Problem statement:** The Canadian dental and Canadian dental hygienists’ associations recommend a child’s first dental visit should occur no later than age 1; however, there has been limited uptake within the dental community. Understanding facilitating factors utilized by dental practitioners who have successfully integrated infant and toddler oral health into their practice is integral to developing strategies to improve uptake of early pediatric dental homes. **Purpose:** The purpose of this study was to explore factors used by oral health practitioners that facilitate provision of a dental home for infants and toddlers in Alberta. **Methods:** This study employed a qualitative, interpretive, descriptive methodology and an ecological theoretical framework. Semistructured individual interviews were conducted with oral health practitioners who routinely provide a dental home for infants and toddlers. Data collection and analysis were concurrent, using purposive sampling and a constant comparative method. Ethics approval was obtained through the University of Alberta (#Pro00061569). **Results:** Eight dentists and five dental hygienists with diverse practice experience and from varied locations (urban, rural) and practice settings (group, solo) were interviewed. Thematic analysis revealed 4categories that facilitate practitioners in the provision of infant and toddler oral health care: the practitioner, practice, profession, and population. These categories are interrelated and include factors both endogenous and exogenous to the dental practitioner. Common endogenous factors include the individual practitioner’s comfort with young children and having clinical exposure within dental education; common exogenous factors include parental awareness and adequate insurance coverage for preventive procedures. **Conclusions:** Strategies to improve uptake of a dental home by age 1 include enhanced practitioner education and public awareness, as well as increased remuneration for preventive early pediatric oral health care. Provision of infant and toddler dental homes is affected by many variables. Consequently, strategies to improve uptake must employ a multipronged approach.

**Problem statement:** Evidence shows that oral care protocols in mechanically ventilated patients are associated with a reduction in ventilator-associated pneumonia. This evidence has resulted in adoption of oral care protocols in intensive care units (ICUs) as standard practice yet surveys show the majority of nurses use foam swabs while a minority use regular toothbrushes to clean the oral cavity. Limited research has focused on patients’ oral health and satisfaction when oral care protocols are implemented. **Purpose:** The purpose of this study was to determine the impact of a standardized oral care protocol on oral health and satisfaction in postmechanically ventilated patients. **Methods:** In this IRB-approved clinical trial, 74 subjects were randomized to a control (toothbrushing, swab rinses) or intervention (battery-operated tooth brushing, tongue scraping, flossing, mouthrinse, lip care) group, administered by nurses, twice daily. The protocol was designed by nursing and dental hygiene faculty. Outcome measures utilized the revised THROAT (R-THROAT: oral cavity assessment) which evaluated lips, gums, teeth, tongue, saliva, smell, and mouth comfort. Categories were assessed on a scale from 1 to 3 (3 = poorest oral health). The overall score was the sum of the 7 categories. Assessments were completed by dental hygienists on days 1 and 4 of each protocol. **Results:** As measured by the R-THROAT, the intervention group demonstrated significant oral health improvement over the control group (R-THROAT = 1.97 intervention vs 0.87 control, p = 0.04). Subjects in the intervention group were more satisfied with their protocol than the control group. **Conclusions:** This study suggests policies and practices related to oral care of postmechanically intubated patients merit further attention. Practices should incorporate innovative protocols to improve oral health. Consideration should be given to collaborating with dental personnel to teach clinical nurses oral care delivery or utilizing dental personnel in hospital facilities to help improve the oral health of patients in ICUs.

**Problem statement:** Epidemiological studies have revealed that older adults who live in residential care facilities (RCFs) have the worst oral health status of all older adults. The scientific literature confirms that one of the main reasons for this problem is that Bachelor of Science in Nursing (BScN) students have inadequate oral health care education (OHCE). On average, student nurses receive 1hour of instruction, and it does not align with best practice guidelines. The existing BScN curriculum has not kept up with the increasing complexity of health care delivery that requires health care providers from unrelated professions to collaborate and deliver coordinated patient-centred care. Developing OHCE for BScN and dental hygiene students is recommended to ensure nurses have the oral health knowledge necessary to ameliorate the health status of their patients. **Purpose:** The purpose of this study was to evaluate the BScN students’ knowledge, attitudes, and perceptions of an oral health interprofessional education (IPE) program. **Methods:** The study college and Central Michigan University’s research ethics boards approved the study. A quantitative descriptive post-test design was used to survey a convenience sample of 47 year-one students at one community college. The validated paperbased measurement tool used in the study contained 10 multiple choice and 20 Likert-type questions. Data were collected after students participated in an IPE session. The tool measured the students’ oral health knowledge and their attitudes and perceptions towards oral health care delivery and IPE. **Results:** The students’ overall scores on all survey items were generally higher than was reported in the literature review for students who did not participate in IPE. **Conclusions:** The study’s findings support an IPE program for BScN and dental hygiene students as a strategy to improve nurses’ oral health knowledge, attitudes, and collaborative skills that may help improve the oral health status of older adults living in RCFs.

**Problem statement:** Upper extremity musculoskeletal disorders (MSDs) are common in the dental professional, and researchers have been challenged with determining preventive strategies to reduce MSDs in dental hygienists. The use of dental magnification loupes has been suggested to minimize risk factors associated with MSDs. **Purpose:** The purpose of this study was to determine the effects of dental magnification loupes on posture during instrumentation. **Methods:** This IRB-approved study comprised a convenience sample of 27 right-handed dental hygienists, with no history of injuries or disabilities of the head, neck or trunk regions. Baseline posture calibrations were taken. Triaxial accelerometers were placed on 4 locations of the head and trunk (occipital region of head; cervical vertebrae C5; thoracic vertebrae T5; lumbar vertebrae L1) to measure acceleration and the orientation of the body to gravity. Mean accelerations of the 3 axes were used to compute average forward/backward (AP) and side-to-side (ML) tilt of each accelerometer. Chair-mounted typodonts with artificial calculus were used to represent a simulated oral environment. Participants were randomly assigned to wear loupes during the first or second half of the experiment and instructed to explore all areas of the mouth using an ODU 11/12 instrument. At the end of the study, an end user opinion survey was completed. **Results:** No statistically significant differences in posture were revealed between participants wearing loupes and not wearing loupes. However, 74% of participants strongly agreed that magnification loupes made exploring easier, and 67% strongly agreed that magnification loupes improved their posture. **Conclusion:** While the majority of participants perceived that magnification loupes enhanced their posture and made exploring easier, the data provided little evidence to suggest that wearing loupes leads to improvement in body orientation. Future research should examine if loupes adjusted with an adequate declination angle can reduce neck and trunk flexion.

**Problem statement:** Surgical loupes have been increasingly popular among dental professionals for their visual and postural benefits. In British Columbia (BC), over 60% of dental professionals practice with surgical loupes and many dental and dental hygiene educational institutions have made surgical loupes mandatory for students. However, dental professionals will only receive the full benefits of surgical loupes if the loupes are fitted to the individual needs of each clinician. Previous research has identified 3 critical criteria for surgical loupes selection and adjustment: working distance, declination angle of the oculars, and coaxial alignment. While the first 2criteria have been thoroughly researched, there remains limited understanding of coaxial alignment of surgical loupes. **Purpose:** Surgical loupes misalignment creates a profound visual disturbance which may have serious impact on the quality of care delivered by dentists and dental hygienists. This study is one of the first to examine the prevalence of coaxial misalignment of surgical loupes among BC dental professionals. **Methods:** A simple quantitative coaxial alignment measurement tool was developed and validated through 2pilot studies. The tool was then used to measure coaxial alignment of surgical loupes for 97 practising dental professionals in British Columbia and for 23 University of BC dentistry students who currently practise with surgical loupes. Data were analysed using Fisher’s exact test. **Results:** The prevalence of coaxial misalignment was 82.5% among the participants. There was no difference in prevalence between dentists and dental hygienists (p = 0.792), nor between students and professionals (p = 0.937). **Conclusions:** This study developed a quantitative tool to measure coaxial alignment of surgical loupes and revealed that a high prevalence of coaxial misalignment is present among BC dental professionals. The results of this study will help dental professionals select surgical loupes best fitted for their practice and will guide surgical loupes manufacturers to develop more evidence-based products.

**Problem statement:** Given the extensive time using scaling instruments and sustaining postures, dental hygienists are prone to developing upper extremity musculoskeletal injuries. **Purpose:** To identify risk factors and establish a predictive model of musculoskeletal injury development in dental hygienists to promote preventive techniques. **Methods:** This IRB-approved, longitudinal, multicohort study has a targeted recruitment of 120 dental hygiene (DH) students (exposed to high-intensity hand activities) and 60 occupational therapy (OT) students (non-exposed control group). Repeated data collection occurs every semester across the 2-year training, including morphology of anatomical structures using sonographic imaging; neurophysiologic function using nerve conduction testing; symptoms/function and exposure to extracurricular hand/wrist activities using questionnaires; and exposure to hand strain and postural assessment during dental scaling using video analyses. **Results:** Currently enrolled DH (n = 53) and OT (n = 55) students are similar in age (DH, 24.4 yrs, SD = 3.5 yrs; OT, 24.8 yrs, SD = 2.6 yrs.) and are primarily right handed (92.5%, 87.3%) females (88.7%, 89.1%). The groups have equivalent grip/pinch strengths, report similar extracurricular activities, and essentially no pain or limitations. A video data collection protocol using 3 cameras positioned in orthogonal views has been established, and a coding process for descriptive characteristics has been validated. Preliminary analyses indicate that students spend an average of 1 hour 45 minutes (SD = 28.4 min.) actively scaling during a patient visit. Good to excellent inter-rater reliability of exposure measures (Revised Strain Index and Rapid Upper Limb Assessment) has been established (i.e., ICCs >0.80). **Conclusions:** Students in both programs have essentially no pain/limitations, nor indicators of pathology; baseline equivalency ensures that injury development can be modeled according to any disparate changes across time between groups. When combined with risks identified through video observations, these data will illuminate targets for enhanced DH education and inform development of DH self-assessment tools to prevent injuries.

**Problem statement:** Tobacco dependency interventions are inconsistently delivered by dental providers. There is a great need to integrate a systematic approach into practice. The introduction of electronic dental records (EDR) offers an opportunity to incorporate best practices using clinical decision support (CDS) to improve care. **Purpose:** The purpose of this study was to understand provider preferences for tobacco CDS and explore the feasibility of embedding such a system. **Methods:** This mixed-methods study was approved by expedited review at HealthPartners Institute and provided qualitative data in support of an effort to seek funding for a randomized clinical trial (RCT) to test a tobacco CDS. First, the providers were surveyed to identify clinics that systemically address tobacco use, utilize EDRs, and identify providers interested in participating in structured interviews. The structured interviews identified what providers are doing to document and assist their patients in cessation. Based on interview findings, a mockup system was developed. Iterative face-to-face interviews were conducted to obtain feedback from practitioners leading to the final design. **Results:** Among 630 surveys sent, 89 were returned (43 dentists, 28 dental hygienists, and 5 unknown). The survey responses identified 76 offices using an EDR to record clinical care. In 70 (95%) offices, smoking status is recorded in the health history. Structured interviews (n = 11) and face-to-face interviews (n = 11) determined that practitioners are interested in a tobacco CDS. **Conclusions:** Tobacco cessation is generally conducted by dental hygienists with support from the dentist. Both have a strong desire for a consistent approach. They see their role as providing resources and referral. The tool must be easy to use, with limited data entry, track patients who are resistant to discussion, and fit into workflow. Many respondents supported the use of web-based patient resources. Information gained from this study will be used to further develop a tobacco CDS intervention to be studied in dental practices.

**Problem statement:** Tobacco use is associated with adverse oral and systemic health effects. Despite declining cigarette use among adolescents, dual and polyuse of multiple tobacco products is increasing. **Purpose:** This study aimed to assess nicotine dependence according to patterns of current tobacco use. **Methods:** 594 adolescent males, a population at high risk of smokeless tobacco (ST) use, at 36 rural California schools (2014–2016) completed in-person surveys. Participants reported their current frequency and lifetime history of using 6 tobacco products (cigarettes, ST, snus, e-cigarettes, cigars, and waterpipes). Participant clusters were defined based on frequency of tobacco use across products. The Hooked on Nicotine Checklist (HONC), a validated scale of adolescent nicotine dependence, was administered to all past-month users of any tobacco product. Approval was obtained from the UCSF Institutional Review Board. **Results:** Seven classes were identified: never-users (43%), those who never tried tobacco; triers (20%), those who tried tobacco, but never used frequently; experimenters/former users (10%), those who used tobacco, but not currently (past-month); infrequent current users (16%), those who used tobacco <10 times in the past month; and 3 classes of frequent current users (combined, 11%): those who reported use of at least one tobacco product =10 times in the past-month: ST-only users (n = 38), ST/combustible dual-users (n = 15), and non-ST users (n = 17). HONC scores were low for infrequent current users (mean = 0.8) but were higher overall (mean = 2.8) and comparable between classes of frequent current tobacco users: ST-only users (mean = 3.3), tobacco dual-users (mean = 2.8) and non-ST users (mean = 1.8) (p = 0.19). **Conclusions:** Nicotine dependence was detectable but low for infrequent tobacco users; among frequent current users, dependence was higher and comparable by tobacco product used. Dental professionals should include all tobacco products in patient assessment and counselling, while tobacco control policy makers should consider dual and polyuse as a potential addiction risk for youth. Funding for this project was provided by grant number 1P50CA180890 from the National Cancer Institute and Food and Drug Administration Center for Tobacco Products and NIH National Center for Advancing Translational Sciences award number KL2TR000143.

**Problem statement:** The global rate of oral cancer is increasing at an alarming rate. A significant source of this burden is South Asia (SA), where the incidence of oral cancer is over 130,000 new diagnoses per year. While several cases have been linked to unique sociocultural habits, many are of unknown etiology. South Asians represent a growing proportion of British Columbia’s (BC) population. Accordingly, a corresponding increase in the number of cancer cases is anticipated. Genetic marker profiling is a validated risk predictor for oral cancer. Loss of heterozygosity (LOH) in key chromosomal loci identified for certain populations remains inconclusive in SAs. Understanding the risk profile of this population is essential to the identification and management of oral premalignant lesions (OPL). **Purpose:** The purpose of this study is to examine the LOH profile of SA oral dysplasias in BC. **Methods:** This study includes a retrospective cohort of 24 SA patients enrolled in the Oral Cancer Prediction Longitudinal Study, with primary OPLs. Lesion biopsies taken prior to 2010 are excluded. DNA extracted from tissue samples are analyzed for LOH at 3p, 4q, 8p, 9p, 11q, 13q, and 17p using polymerase chain reaction and microsatellite assay. DNA extracted from the connective tissue of the same sample acts as control. IRB approval was obtained from the UBC-BCCA research ethics board. **Results:** The mean age is 52.2 years; 71% are men; 25% are smokers. The most common site is the ventrolateral tongue at 66.7%, with 45.8%, 33.3%, and 16.7% presenting as mild, moderate, and severe dysplasia, respectively. Preliminary results show frequent LOH at 9p and 3p; 4q is infrequently lost. **Conclusions:** There may be some variation in the genetic risk profile of SA OPLs in BC. Education, screening, and treatment targeted to this ethnic subgroup will be crucial in the management of OPLs. Funding for this project was provided by UBC Dentistry Research Award, BC Cancer Foundation.

**Problem statement:** Patients have difficulty adhering to recommendations for biofilm removal, which is important for preventing gingivitis. Images and text messages are promising tools to increase patient motivation and selfregulatory efforts for dental hygiene behaviour, but efficacy needs to be tested. **Purpose:** This study investigates the effects of using an intraoral camera (IOC) during supportive periodontal therapy (SPT), oral hygiene short messages (SMS) between appointments, or both on clinical, behavioural, and psychological parameters of patients with gingivitis. **Methods:** Adult patients (N = 203) receiving SPT were randomly assigned into 4 conditions: IOC, SMS, IOC+SMS, and Usual Treatment. Bleeding on marginal probing (BOMP), brushing and flossing behaviours (primary outcomes), and social cognitive determinants of behaviour change (outcome expectancies, action and volitional self-efficacy, intention, and planning) were evaluated at baseline, 4 months, and 8 months later. Mixed-effect modelling was employed to verify if change occurred in study outcomes. The ethics committees of the institutions involved approved the clinical trial (Ethic Committee Doc.No.6/14). **Results:** Compared to the control group, all treatment conditions improved flossing (BIOC = –0.446, p = 0.001, BSMS = –0.436, p = 0.006, BIOC+SMS = –0.611, p < 0.001), and revealed a significant decrease in BOMP (BIOC = 0.269, p < 0.001, BSMS = 0.249, p < 0.001, BIOC+SMS = 0.493, p < 0.001) from baseline to 4 months with no differences between 4 and 8 months. When compared to the control group, individuals in the IOC+SMS condition had more positive outcome expectancies, higher levels of action selfefficacy and intention from baseline to 4 months with no differences between 4 and 8 months. Volitional self-efficacy was reinforced in all treatments. **Conclusions:** Mixedmodel results indicate significant interaction effects for primary and secondary outcomes (flossing, dental hygiene, BOMP, and psychological determinants). The coaction benefit in using IOC in consultation while receiving SMS between appointments improves clinical, behavioural, and psychological parameters of periodontal health 4 months after treatment, maintained in 8 months’ follow-up.

**Purpose/Goals:** Principles of Dental Hygiene I Clinic is an introductory course aimed at integrating foundational scientific knowledge and clinical skills used in delivering comprehensive dental hygiene patient care. A technologyenhanced redesign of the course using multimedia lessons was undertaken to increase student preparedness for application of dental hygiene skills and collaboration during class sessions and to improve student-learning outcomes. **Significance:** A technology-enhanced redesign of the course was developed to prevent double-teaching; increase practice time; standardize step-by-step instruction to diverse learners; offer comprehensive demonstration videos with ability to pause, skip, and repeat viewing; provide close-up views that cannot be seen in group demonstrations; and offer enhanced 2D and 3D graphic animations of anatomical structures and instrumentation in subgingival tissues. **Approach/Key issue:** This technologyenhanced redesign of the course supports blended learning and a flipped classroom environment with the use of multimedia lessons. Students of the Principles of Dental Hygiene I Clinic course review required readings, watch videos, and complete knowledge check questions and online quizzes prior to class. Dental hygiene techniques are practised on typodonts in the simulation lab, and with partners in a clinical setting. **Evaluation:** As a result of the multimedia lessons, the students have shown to be better prepared for application and collaboration during class sessions, having had the opportunity to learn at their own pace in this media-rich environment. Students and faculty were surveyed anonymously. Ninety-seven percent of students stated improvement in their learning and performance of skills compared to topics in the course without the multimedia lessons. One hundred percent of faculty perceived students who viewed the multimedia lessons as better prepared. There was an improvement in student learning outcomes, with an 8% increase in course average scores and a 45% reduction in student failures.

**Problem statement:** Since 1996 in Australia and New Zealand, the education of dental hygienists and dental therapists has almost exclusively undergone a change to a combined outcome degree graduating oral health therapists. In parallel, regulatory frameworks have emerged allowing a wider range of practice settings, scopes. and business models. **Purpose:** The objective of this presentation is to examine the education, regulation, and practice of oral health therapists in Australia to inform planning and leadership in profession, education, and policy internationally. **Methods:** This presentation will draw on Australian accreditation standards, curriculum frameworks, regulation, and practice activity research to explore the educational preparation, scope of practice, and application to both private and public sector practice. Research to inform this paper includes studies examining dental therapists’ practice in private sector employment; the ability of dental hygienists to diagnose and treatment plan oral health care for people in residential aged care settings; the ability of dental therapists to provide restorative care to adults, and a recent national oral health practitioner practice activity study*. **Results:** Dental therapy practice has been readily accepted in the private sector, dental hygienists are recognized as capable of diagnosing and treatment planning their own care even for high-needs people, dental therapists are able to deliver restorative care to at least the same standard as a dentist, and oral health therapists’ practice activity (although varied in different practice settings) reflects their utilization as both therapists and hygienists. Regulation in Australia has also changed over time to reflect this evidence, and oral health therapists are now well accepted members of the dental team. **Conclusions:** The results of these studies offer insights into the utilization and practice of combined dental hygienist/therapists (oral health therapists), and an examination of recent regulatory developments will flag the directions of change in oral health workforce demands in Australia. **The author has been an investigator on all four of these studies.*

**Problem statement:** Increased consumption of free sugars is recognized as a risk factor for many chronic health problems; more specifically, studies have demonstrated significant associations between sugary drink intake and caries experience. Dental practitioners agree that dietary counselling is essential for caries prevention; however, they provide advice infrequently due to a lack of confidence and competence. **Purpose:** The purpose of this project was to improve dental practitioners’ practices through an online training module exploring the use of a brief counselling method and a diet assessment of caries risk form. **Methods:** This project was conducted as a prospective cohort study, using convenience sampling. Phase 1: dental practitioners (dentists, dental hygienists, and dental therapists, n = 41) completed a survey on current practices and confidence in providing dietary advice, followed by an online training module that was pilot tested among dental academics. Participants completed a 6-month follow-up survey exploring changes in confidence and perceived barriers as a result of their online training. Phase 2: ten dental hygienists were then involved in the patient phase of the study, including recruiting patients, eliciting a diet assessment of caries risk, and using brief counselling techniques. Patients were followed up at 6 months for a risk assessment review. **Results:** A statistically significant improvement in confidence when providing nutritional advice was observed among participating dental hygienists. A paired sample t-test was performed using the data from the patients who completed baseline and follow-up risk assessments. Patients (n = 64) showed a significant reduction in high-risk behaviour pertaining to quantity and timing of sugar intake, and significant trends in improvement of behaviours relating to frequency, exposure time, and drinking style (p < 0.05). **Conclusions:** It appears that a simple online learning module can improve dental hygienists’ confidence in dietary advice provision and have a positive impact on patient behavioural change within a relatively short timeframe.

**Problem statement:** AgP comprises a group of rapidly progressive forms of periodontitis generally characterized by an early age of clinical manifestation and a distinct tendency to aggregate in families. Research has suggested multiple etiologies for AgP, but no common mechanism. **Purpose:** The overall goal of this study is to determine if downregulation of loricrin leads to impairment of epithelial barrier function and increased levels of inflammation and bone destruction in the periodontium in response to the causative bacteria of AgP. Revealing the underlying mechanism in AgP will dramatically change early diagnosis of this complex disease and ensure that susceptible patients are treated promptly to reduce long-term morbidity and quality of life issues. Mechanistic insight will also enable the development of new intervention strategies. **Methods:** Gingival samples from periodontal healthy patients and AgP patients undergoing routine periodontal surgeries in which the tissue is normally discarded are being collected. The western blot and qPCR for protein detection and gene quantification, respectively, will be used. These methods will allow us to determine if these AgP patients experience a downregulation in loricrin. This study was approved by the research ethics board of the University of Alberta (Pro00062112). **Results:** Twelve of forty samples have been collected. Using western blot analysis, a protocol that detects loricrin in human skin and mouse oral tissue samples has been successfully established. Next, a qPCR protocol will be developed to determine if there are changes in gene expression. **Conclusions:** Overall, this proposal addresses a devastating childhood illness by testing a novel hypothesis using innovative study designs. Conceptually, it challenges the current focus of research in AgP and may lead to new research and therapeutic directions. This project is funded by the University of Alberta Hospital Foundation, the University of Alberta Dental Hygiene Fund, and the Fund for Dentistry.

**Problem statement:** Studies have shown Indigenous populations feel unsafe when accessing mainstream health care services due to fear of being racialized and stigmatized. To help improve access to timely health care, Canadian medical and nursing bodies have integrated Indigenous cultural competency and safety training into their curricula. However, dental and dental hygiene education focus little on this content. **Purpose:** The purpose of the study was to bridge the historic context of Indigenous peoples, understanding their contemporary oral issues and inequities and integrating them into dental hygiene curricula, and to evaluate and measure students’ knowledge, attitudes, and feedback. **Methods:** A talking circle was conducted with 8 men and 10 women from a Vancouver Indigenous community group to explore their perspectives of and experiences receiving oral care. Information gained from the talking circle and literature was used to develop 9 hours of curricula for 49 dental hygiene students. Indigenous guest speakers strengthen the cultural content of the curricula. At each session, students’ levels of knowledge were evaluated with pre and postassessments and measured with t-tests (IBM SPSS Version 22.0). The University Behavioural Ethics Board approved the project. **Results:** Students’ level of knowledge increased significantly around Indigenous health and oral health, residential school system and intergenerational trauma, and concepts of cultural competency and safe oral care (p < 0.001). Connecting cultural content with personal stories shared by Indigenous community members reinforced students’ learning. Students suggested that a future opportunity to work directly with communities would be most beneficial to their overall learning of Indigenous content. **Conclusions: **Incorporating Indigenous history and health context into dental hygiene curricula is a plausible approach to help address the knowledge gap in understanding oral health challenges and inequities among Indigenous populations. Dental experiences of Indigenous peoples who have received care by dental hygienists trained in cultural safety require further exploration.

**Problem statement:** Dalhousie University Faculty of Dentistry provides dental hygiene care to new immigrants who are clients of the Immigrant Services Association of Nova Scotia (ISANS). Research indicates health outcomes are enhanced when individuals receive care in their own language. ISANS provides a limited number of professionally trained interpreters, therefore recruitment of volunteer dental and health professions students and faculty was necessary to interpret medical histories and explain treatment options. This approach led to concerns regarding the effectiveness of using untrained interpreters with various health care backgrounds in a dental setting. **Purpose:** Evaluate the perceived benefits of using trained versus untrained interpreters with diverse health care backgrounds in an immigrant dental hygiene clinic by exploring the experiences of the care providers, supervising faculty, and interpreters. **Methods:** An original survey containing 13 items was distributed to dental hygiene students (n = 26), faculty (n = 9), and interpreters (n = 35) involved in the ISANS clinic. Closed-ended questions were summarized using descriptive statistics. Open-ended questions were examined for common themes. This project was approved by the Dalhousie University Research Ethics Board. **Results:** All faculty and 95% of students reported interpreters with backgrounds in health care were helpful in the ISANS clinic, with 84.6% and 71.4%, respectively, preferring to collaborate with the untrained volunteer interpreters, specifically since many were dental students. Both untrained volunteer and trained ISANS interpreter groups felt they aided in the treatment of patients in a culturally competent manner and their assistance was an overall benefit to both the student and ISANS patient. Faculty (85.7%) and students (66.7%) reported they would not feel comfortable treating an ISANS patient without an interpreter. **Conclusions:** This study revealed that interpreters with various health care backgrounds are useful in an immigrant dental hygiene clinic. The untrained interpreters were preferred over professional ISANS interpreters.

**Problem statement:** An examination of epidemiologic data from the partnership between the Robert Wood Johnson Foundation (RWJF) and the University of Wisconsin-Population Health Institute (UWPHI) consistently ranked the studied service county in the lower quartile of the state for both quality of care (QoC) and quality of life (QoL) measures. Researchers determined QoL might be more accurately measured using a satisfaction survey. Families were asked about their perceptions of care received and if their QoL was impacted. **Purpose:** The purpose of this follow-up study was to identify how families served through county-based health programs felt about the QoC received, and how QoL was impacted. **Methods:** A cross-sectional research design was used. An electronic survey was sent to a convenience sample of families with children receiving care (n = 108). The survey consisted of 25 closed-ended questions using a 4-point Likert scale. Satisfaction survey questions had previously established content validity and reliability. Informed consent was obtained after IRB approval (UWSP-expedited 3242014) before survey administration. Responses were anonymized and kept confidential. Descriptive statistics were used to report the data. **Results:** A response rate of 27.2% (n = 30) was obtained. Overall satisfaction with the public health facility received ratings of either excellent (43.33%) or good (56.67%). Of the 30 participants, 29 reported families’ dental needs were addressed with either an excellent (63.33%) or good (36.67%) overall quality rating. Overall, family members reported complete satisfaction with the care received, and the QoL was positively influenced (100%). **Conclusions:** Data documented families in countybased programs were satisfied with the QoC received and reported that QoL was improved in comparison to state and national epidemiologic data.

**Problem statement:** The current impasse in the community water fluoridation (CWF) controversy is problematic for public health. Beyond the issue of best evidence, CWF encompasses other factors—ethics, values, authority, power, and credibility. **Purpose:** Our objective was to understand key stakeholder views about challenges and opportunities in communications about CWF and broader public health concepts such as equity and health. **Methods:** This study received research ethics board approval. Dental hygienists from a linked quantitative study, who consented to future contact from the research team, were invited to participate in followup focus groups. The discussion guide aimed to encourage participants to share and understand diverse views about health, health equity, population-level policies in general, and CWF. Thematic analysis was guided by literature on the public engagement of science and the expert–lay divide, as well as theory of power relations between health professionals and the public. Implications for communication at the client and public health level were drawn. **Results:** Analysis of data from 4 focus groups revealed several challenges for dental hygienists when communicating about CWF with members of the public. These challenges centred around 3 themes: evidence confusion (e.g., breadth of and multiple disciplines involved in fluoridation literature), authority and expertise (e.g., perceived mismatch between public health and private practice about fluoridation, patient knowledge), and messaging issues (e.g., caries risk factors beyond fluoridation). Dental hygienists viewed health communication as a process that involves building trust over time and recognized client knowledge as important. **Conclusions:** This study underscores that dental hygienists are aware of and value 2-way health communication techniques in practice. They also have a strong understanding of the impact of trust in the health relationship. Nevertheless, communication challenges around CWF persist, and solutions to those challenges will need to consider the breadth of multidisciplinary evidence, topical versus systemic fluoride, and explaining population- versus individual-level interventions. Funding for this project was provided by an Eyes High Postdoctoral Scholarship from the University of Calgary and an Applied Public Health Chair (CIHR–Institute of Population & Public Health, Institute of Musculoskeletal Health & Arthritis) grant.

**Problem statement:** Periodontal disease is a chronic disease worldwide that is highly influenced by socioeconomic status. **Purpose:** The purpose of this study was to determine the relationship between socioeconomic status and self-reported periodontal symptoms. **Methods:** This study was conducted after receiving approval from the institutional review board at the Korea Centers for Disease Control and Prevention (IRB No: 2011-05CON-04-C, 2013-06EXP-01-3C). This cross-sectional study used data from 210,432 (weighted n = 36,294,413) and 220,396 (weighted n = 39,067,134) subjects of the 2011 and 2013 Community Health Surveys, respectively. All subjects were community residents aged =19 years who lived in the sampled households in each year. Prevalence rates of tooth mobility, gingival swelling, calculus, and gingival bleeding were determined. Independent variables were sex, age, and socioeconomic status (i.e., occupation, education level, and income). Differences in self-reported periodontal symptom rates according to socioeconomic status were determined using independent t-tests and one-way analysis of variance. **Results:** Approximately 30% of subjects reported at least 1 periodontal symptom; specifically, in 2013, 11.1%, 10.3%, 4.5%, and 4.4% reported gingival swelling, gingival bleeding, dental calculus, and tooth mobility, respectively. More women (31.4%) than men (29.1%) reported periodontal symptoms. Of the subjects aged =60 years, 34.2% reported periodontal symptoms, while only 23.4% of those in their twenties did so; thus, selfreported periodontal symptoms appeared to increase with age. Prevalence of self-reported periodontal symptoms differed by socioeconomic status (p < 0.01). **Conclusions:** Self-reported periodontal symptoms differed according to socioeconomic status: subjects with a low socioeconomic status reported more advanced periodontal symptoms (e.g., gingival swelling), whereas those with a higher status reported more incipient symptoms (e.g., gingival bleeding).

**Problem statement:** To expand the profession of dental hygiene, knowledge translation of research for integration into practice is crucial. Recently, Korea has established an academic classification category for dental hygiene. We identified the research agenda subcategory of “social dental hygiene” as an area needing development. Social dental hygiene considers the community, society, culture, circumstance, and environment surrounding the individual as factors for improving the oral health of the population. **Purpose:** The purpose of this study was to develop the subcategory “social dental hygiene” for the Korean Dental Hygiene Research Agenda. **Methods:** This study utilized a Delphi survey method. Surveys were sent to the chairpersons of the Korean Dental Hygienists’ Association and its subsocieties via email (n = 8). All participants provided informed consent (IRB YWDS2015- 03-002). Chairpersons’ opinions were grouped into the following categories: basic science, clinical, social, and educational dental hygiene. The categories were then classified into “health promotion/disease prevention,” “health services research,” “professional education and development,” and “occupation health and safety,” according to the ADHA National Dental Hygiene Research Agenda (2007). The research agendas were compared with the articles published in 2 Korean journals (JKDH, JDHS) and one international journal (IJDH) from the first issue to December 2014. **Results:** Among 129 identified research priorities on the Korean agenda, social dental hygiene priorities numbered 44 (34.1%) items. Eleven priorities about oral health necessity or epidemiology have already been preliminarily studied to determine factors influencing oral health. Thirty-three priorities about oral health policy have not yet been studied. The newly developed priorities for social dental hygiene have not been studied. **Conclusion:** Previous dental hygiene studies in Korea were focused on discovery of new knowledge, including social factors that influence oral health. The new Korean Dental Hygiene Research Agenda aims to enhance knowledge translation to dental hygiene practice.

**Problem statement:** Empowering learners to effect change implies that learners acquire lifelong learning skills; one such skill is critical thinking. Critical thinking is a highlevel cognitive function desired in graduates of higher education, including professional education programs such as dental hygiene. Research on the general topic of dental hygiene education is limited; research specific to critical thinking in dental hygiene education is even more rare. Purpose: This research is designed to deepen understanding of dental hygiene students’ perceptions and experiences of acquiring critical thinking skills in their professional education. **Methods:** A basic qualitative study was selected to start the discussion, and data were gathered during a focus group followed by individual interviews. Research ethics board approval was obtained. The purposeful sample comprised 7 recent graduates of the final 2-year cohort of a community college-based dental hygiene program in Ontario, Canada. Inductive data analysis using an interpretive perspective was conducted to identify categories, patterns, themes, and ultimately meaning to address the research questions. **Results:** Participants indicated their critical thinking began with acquiring base knowledge of theory related to dental hygiene followed by developing a thought process using case-based learning with small group work and discussion. Participants valued being offered a variety of activities to develop their critical thinking, such as problem-based learning, active learning, and cooperative learning. Participants also acknowledged the role of confidence, emotions, and time constraints, thinking outside the box, and reflection as facilitators. The clinical setting was noted as a real and challenging environment in which to apply critical thinking and to see it modeled. **Conclusions:** Many of the findings of this exploratory study align with research on developing critical thinking in adult education and professional education. This basic qualitative study provides beneficial preliminary information about how dental hygiene students learn critical thinking skills. ©2018

**Problem statement:** Transitioning from paper textbooks to interactive e-textbooks has been considered revolutionary in terms of enhancing student learning. Students termed the “net generation” have grown up with technology, and it is assumed they embrace technological options such as e-textbooks. However, this technology in higher learning has been met with hesitation. **Purpose:** This research study investigated student and faculty perspectives of mandatory e-textbooks in a dental hygiene program. **Methods:** Ethics approval was obtained from the university’s Research Ethics Board (#Pro00072859). The student questionnaire utilized a 5-point Likert scale (strongly disagree [1] to strongly agree [5]) and examined convenience; compatibility with learning style; perceived enjoyment; and perceived usefulness. Student use frequency for each text was collected. Open-ended questions captured benefits and challenges. A focus group gathered perspectives from faculty (5 of 10) who required an e-textbook. Descriptive statistics were calculated for questionnaire data, and narrative analysis was used for open-ended questions and focus group transcripts. **Results:** Survey completion was 48% (50/105). Overall, students disagreed with the utility of this e-textbook platform, scoring all factors below neutral. Results of students’ ratings of 4 categories showed convenience (M = 2.75, SD = 0.92); compatibility (M = 1.93, SD = 0.83); perceived effectiveness (M = 2.15, SD = 0.90); and perceived usefulness (M = 2.36, SD = 1.04). A high correlation between all factors suggests the utility factors were uniformly rated by students. On average, 71% of students did not use their textbook more than once a month. Benefits were few and challenges included technical glitches, eyestrain from screens, cost, and inability to choose books for purchase. Faculty’s perspectives aligned closely with the students’ responses, but they appreciated portability of texts and quality of clinical images. **Conclusions:** Students strongly dislike e-textbooks; they do not read e-textbooks, but study from condensed, summarized presentations. Faculty felt e-textbooks do not align with positive student learning experiences and mostly preferred traditional paper texts for their teaching.

**Problem statement:** Thorough debridement is the basis of periodontal treatment and a profound segment of dental hygiene expertise. Studies indicate that Canadian graduates use ultrasonics with an outdated (traditional) approach resulting in an “unconsciously incompetent” clinician. Purpose: This study tested a revised ultrasonic curriculum aimed at producing a more “consciously competent” graduate. **Methods:** This convenience sample study measured both ultrasonic process and outcomes for graduates from an accredited Canadian school (n = 17) vs the following year’s graduating cohort (n = 18) after implementation of a novel ultrasonic curriculum. Methods comprised enrichment of ultrasonic theory, preclinic and clinic content, including problem-based learning, critical thinking, and faculty calibration. Graduates were evaluated “in process” via a validated, indexed rubric on 4 foci: equipment preparation, infection control, clinician positioning, and instrumentation technique by the investigators following calibration exercises. Post-scaling, the teeth were removed from the identical typodonts, anonymized, and scored for “outcomes” via tested grid calculations for 3 types of standardized deposits: heavy/ tenacious, light, and biofilm. Ethics approval was obtained from Niagara College, Ontario. **Results:** From a potential 510 points for in process skills, the baseline graduates achieved a mean score of 112.3 vs 295.6 for the enhanced curriculum cohort. Outcomes debridement measured the baseline group leaving 10.5 grids of tenacious calculus, 23.3 grids of light calculus, and 60.18 grids of biofilm from a potential of 72 each. The enhanced curriculum cohort left 4.1, 7.4, and 39.3 grids, respectively. A 2-tailed, unpaired t-test measured statistical significance. All p values show statistical significance between the mean scores at the 0.01 level. **Conclusions:** The enhanced curriculum produced graduates with process improved by 263.1% (p < 0.0001). Debridement outcomes were enhanced similarly. This study suggests that an enriched ultrasonic curriculum can be inserted into an existing dental hygiene program with vastly improved results.

**Problem statement:** Contemporary ultrasonic instrumentation (UI) has improved due to biofilm and light deposit removal and enhanced subgingival access. However, it is unknown if dental hygiene curricula have kept pace with this progress. Purpose: The purpose of this study was to assess dental hygiene UI curricula from program directors’ perspectives. **Methods:** Thirty-nine Canadian program directors were invited to participate in an electronic survey containing closed- and open-ended items about current UI curricula, with the latter qualitative items focused on educational objectives and clinical criteria for UI implementation. The study received ethics approval from the University of Manitoba; responses were kept confidential. The survey was pilot tested with a small convenience sample to establish clarity and validity. Quantitative analyses were primarily descriptive statistics including frequencies, proportions, and means. Narrative data underwent inductive qualitative thematic analysis. Sensitizing concepts identified from previous research were used for developing codes. Codes were analysed to identify themes. **Results:** The response rate was 47.5%. Timing of the introduction to UI was widely varied. UI theory, preclinical, and clinical training ranged from 2 hours to 20 hours, 0 hours to 12 hours, and >20 hours, respectively. A reliance on guest speakers (90%) and textbooks (95%) was observed. Student evaluation was reported mostly based on observation, with and without examination (21%, 36%) primarily without assessment rubrics (21%). While criteria for ultrasonic use were client based, some aspects of criteria were not theoretically established. Program objectives were predominantly theory as opposed to clinically focused. **Conclusions:** The study demonstrated several deficiencies in Canadian dental hygiene UI curricula. Shortcomings primarily surrounded a lack of instilling evidence-based, contemporary approaches for UI into all curricular elements. The authors recommend careful reviews, modifications, and future evaluations of ultrasonic curricula within Canadian dental hygiene programming.

**Problem statement:** Dry mouth is a complex condition impacting many older adults. Older adults frequently attend undergraduate dentistry and dental hygiene student clinics. **Purpose:** The purpose of this study was to document the incidence of dry mouth and assess the management protocols recommended by dental and dental hygiene students. The project also evaluated associations between age, medical history (i.e., systemic conditions), medication use, as well as frequency and type of treatment goals when salivary change was noted in the clinical assessment findings. **Methods:** This retrospective chart review collected data from electronic patient records. Study approval was obtained from the university’s Research Ethics Board (protocol # Pro00065611). Records from 2014–2016 were selected if changes in saliva were noted. Data analysis was completed using SPSS. Frequencies were displayed as percentages and associations between variables were examined. **Results:** AxiUm database revealed 250 pertinent patient charts from 4934 patients seen. Results showed students do not frequently mention dry mouth in the treatment plan, with only 13% (n = 33) of patients receiving recommendations for managing dry mouth. Patients who received recommendations were over 70 years of age. Students rarely include dry mouth in the diagnosis (n = 29) and, when it was documented, patients had a comorbidity of autoimmune disorders (n = 18); taking antidepressants (n = 8) or other medications (n = 10). If dry mouth was noted in the treatment plan, students recommended nothing (n = 12), Biotène products (n = 11) or various other agents (n = 10). **Conclusions:** Findings indicate dental and dental hygiene students identify changes in salivary flow during clinical assessment. However, few students provide recommendations to support patients in managing dry mouth. Further research is required to examine reasons why advice for managing dry mouth is rarely provided to patients, as well as to consider the feasibility of implementing a diagnostic test into clinical protocols to better assess and define a person’s dry mouth.

**Problem statement:** Clinical examinations in dental hygiene education assess a variety of student competencies regarding application of knowledge and skills in an authentic setting. However, this analysis of competence is rarely returned to students in the form of constructive feedback. Confidentiality and time constraints often limit feedback for these intensive examinations. Purpose: To develop an assessment blueprint for providing structured quality feedback following a dental hygiene clinical examination. **Methods:** One dental hygiene examination at the University of Alberta involves comprehensive client history taking, including identifying risk factors contraindicating or requiring modification to treatment. Using entry-to-practice dental hygiene competencies detailed by the Canadian Dental Hygienists Association, an assessment blueprint with test items mapped to competencies was developed. Competencies relevant to the examination were identified and grouped based on similarity into overarching domains. Test items were then mapped to domains, allowing students’ scores by domain to be calculated (without revealing the confidential test items themselves to the students). Feedback was based on student performance per domain and included overall scores, domain descriptions, how to improve, cohort comparisons, and relevant competencies. **Results:** The blueprinting process identified 4 domains as essential to the history-taking examination: eliciting essential information, effective communication, client-centred care, and interpreting findings. This process also aided the test development, as an inadequate number of test items for assessing client-centred care was identified through the blueprinting. Feedback reports were successfully delivered through online mechanisms to all dental hygiene students following their history-taking examination, in December 2016. **Conclusions:** Blueprinting dental hygiene competencies and test items to examination domains provides a mechanism for structured, confidential, and efficient feedback following clinical examinations. Additionally, this process further validates the examination itself by revealing missing or irrelevant test items. This assessment blueprinting process can be used to provide feedback for any dental hygiene clinical examination. Funding for this project was provided by University of Alberta, School of Dentistry, Educational Research Scholarship Fund.

**Problem statement:** Formative assessment is essential to monitor student progress. Quizzes can be conducted using student response systems (SRS), otherwise known as “clickers.” Advantages of SRS include increased student participation, interactivity, promotion of class discussion, instant availability of results, and immediate feedback. However, faculty may hesitate to incorporate SRS due to perceived difficulty in learning and using the system by their students. **Purpose:** This study (CUNY IRB approval #2015-0464) evaluated the students’ perceptions about incorporating SRS and peer learning using clickers in the first-semester dental hygiene course, Oral Anatomy (DEN1112). **Methods:** The SRS (ELMO, New York, USA) was used for weekly quizzes in DEN1112. In fall 2015, students completed a 6-question, anonymous, paper-based survey about their experiences with clickers before and after the course and their views on SRS as an assessment tool for quizzes. In fall 2016, peer-learning activities were introduced in quizzes using clickers. After submitting their initial answer, students were allowed to discuss selected quiz questions in small groups and answer the question again with only their second answer recorded. In 2016, student surveys included 2 additional questions about these peer-learning activities. Results were analysed by descriptive statistics. **Results:** One hundred sixty students participated in the survey in 2015–2016. Although the majority (74.4%) of respondents were not familiar with clickers before DEN1112, at the completion of the course 58.8% of them felt “very comfortable” and 32.8% were “somewhat comfortable” using SRS. In 2016, 86.8% of respondents found peer-learning small-group activities using clickers “very helpful,” and 31 students (40.8%) explained in the optional comments how those activities were beneficial to them. Most respondents (90.8%) estimated that they changed their initial answer 50% of the time or less following small-group discussions. **Conclusion:** The majority of students easily adapted to clickers and embraced the interactivity, discussion, and peer learning augmented by the SRS.

**Problem statement:** In 2015, the Canadian Dental Hygienists Association published the first Canadian Competencies for Baccalaureate Dental Hygiene Programs. To date, we have no scientific evidence to support that graduates from baccalaureate programs have gained these abilities. Purpose: To explore the confidence levels of senior dental hygiene baccalaureate students in their ability to demonstrate national baccalaureate competencies. **Methods:** This is a 3-year longitudinal study involving senior students enrolled in the University of British Columbia dental hygiene baccalaureate program. Following university ethics board approval, an online, anonymous survey was conducted with senior students to rate their confidence level based on a 5-point scale ranging from “not confident” to “confident” in the national competencies that include 13 domains with 110 associated subcompetencies. This abstract is directed to the frequency data of graduating students from the March 2017 survey as their data reflect confidence at graduation. **Results:** Seventeen of 22 fourth-year students responded to the survey for a 77% response rate. Ratings of “mostly confident” and “confident” scores were summed to explore the number of subcompetencies within each domain in which 75% to 100% of respondents indicated such confidence. The competency areas in which they expressed the highest confidence included collaboration (100%), clinical therapy (100%), oral health education (90%), disease prevention (86%), professionalism (82%), and integration of knowledge (80%). Areas in which they expressed the least confidence included policy use (20%) and advocacy (11%) where many respondents were “not confident,” “somewhat confident” or “unsure.” **Conclusion:** These data provide the faculty with important insights to support curriculum revisions to promote deeper experiences in such areas as policy use and advocacy. It also helps to contribute to a broader national discussion about the baccalaureate competencies to explore subcompetencies that may be beyond the scope of baccalaureate education.

**Problem statement:** Dental hygienists must be competent in evidence-based practice (EBP) to uphold the ADHA Standards for Clinical Dental Hygiene Practice. Purpose: The purpose was to compare EBP knowledge, attitudes, access, and confidence (KACE) between entry-level dental hygiene students and registered dental hygienists (RDHs). **Methods:** A convenience sample of entry-level dental hygiene students and RDHs was used. Participants enrolled in an EBP course completed the validated KACE survey the first week and last week of the course. IRB approval was obtained from Texas Woman’s University. Repeated measures analysis of variance (ANOVA) was conducted to determine if there was a significant positive change in knowledge, attitudes, access, and confidence from pretest to post-test and if there was a significant interaction between group and time. **Results:** Thirty-eight dental hygiene students and 43 RDHs were in each group (N = 81). In all 4 dimensions of KACE (knowledge of EBP, attitudes towards EBP, accessing evidence, and confidence in critical appraisal), there was a significant increase between pre- and post-tests for students (p < 0.001). However, for RDHs, there was only a significant increase in 2 dimensions: knowledge of EBP from pretest (M = 2.67, SD = 1.39) to post-test (M = 5.38, SD = 1.88), p = 0.044 and attitudes towards EBP from pretest (M = 3.78, SD = 0.40) to post-test (M = 4.19, SD = 0.38), p = 0.012. **Conclusion:** Dental hygienists should engage in formal training in EBP upon entrance into a dental hygiene program and training should continue throughout the program.

**Problem statement:** Continuing education (CE) maintains and enhances the job skills of health care professionals. Most dental hygienists are women, and in some cases their careers are interrupted because of marriage, childbirth, and child care. After a certain period, these career-interrupted dental hygienists and dentists will hope to be reinstated and provided CE. **Purpose:** The purpose of this study was to investigate the CE needs of career-interrupted dental hygienists and dentists. **Methods:** A total of 154 participants (83 dental hygienists and 71 dentists) completed an online questionnaire. All participants were members of their respective professional associations in Gyeonggi, Korea. The independent variable was occupation, and the dependent variables were reasons for career interruption and type of CE needed. Frequency analysis and descriptive statistics were used to determine participants’ general characteristics, differences in reasons for career interruption, and CE needs. Responses were analysed using an independent t-test with the PASW statistics 22.0 program. **Results:** All dental hygienists were women (mean working experience: 4.4±18.5 years), while most dentists were men (95.7%; mean working experience: 18.5±6.0 years). Dental hygienists and dentists were both positive after returning to work. However, dental hygienists showed a higher need for CE for job training in “dental assistance” and “preventive care.” Whereas, dentists showed a high need for CE related to “hospital management” and “administration.” CE needs related to “special needs patient care” was low for both groups. **Conclusions:** Dental hygienists and dentists differed in their reported CE needs after career interruption. Funding for this project was provided by the Gyeonggi province branch of the Korea Dental Hygienists Association.

**Problem statement:** There is a gap in the literature with regards to our understanding of stress and well-being among dental hygiene and dental therapy students (DHDTS). A recent study used the Scale of Positive Well- Being, the Adult Hope Scale, and the Values Questionnaire in conjunction with the widely used Dental Environment Stress questionnaire to explore stress and well-being in a combined program of DHDTS in one UK school. The findings showed that students reported high scores of psychological well-being at the same time as high sources of stress, and provided baseline data for this comparative study. **Purpose:** To compare findings of sources of stress and well-being among DHDTS studying a combined program in the UK and in Australia, for clearer understanding of what role a country’s institutional environment and curriculum has on students’ perceptions. **Methods:** A questionnaire that included the Dental Environment Stress questionnaire (DES); Depression Anxiety Stress Scales (DASS-21); Scales of Psychological Well-Being (SPWB); Valuing Questionnaire (VQ); and the Adult Hope Scale (AHS) was distributed to all students in years 1, 2, and 3 DHDTS at the University of Portsmouth Dental Academy in the UK, and at La Trobe Rural Health School in Australia. Data were collected on students’ perception of levels of stress and well-being. Statistical analyses were undertaken using SPSS™ software. Mann-Whitney U tests with Bonferroni corrections were used as multiple pairwise tests were performed on a single set of non-parametric data, to set significance at p < 0.002. **Results:** A response rate of 58% (n = 42, UK) and 55% (n = 46, Australia) was achieved. Clinical factors and academic work were perceived as stressful for DHDTS in both the UK and Australia. The Australian DHDTS perceived stress in the educational environment was significantly higher (p < 0.002) than the UK DHDTS. All students reported high levels of positive well-being, with no significant differences between the 2 groups. **Conclusions:** DHDTS in the UK and Australia identified sources of stress within their undergraduate education, but also perceived themselves as positively functioning individuals.

**Problem statement:** Dental hygiene diploma graduates who immediately continue into degree-completion studies undergo a change from a clinically focused, hands-on learning environment to an experience focused on higher order concepts such as critical thinking, conceptual writing, research use, and health care advocacy. This shift in learning experience forces students into a “liminal space,” suspended between old and new levels of education. Understanding this pre-liminal state will allow educators to better support students as they begin their degree studies. **Purpose: **The purpose of this research project is to examine perceptions of dental hygiene students on the pre-liminal phase experienced when moving from diploma to baccalaureate education. **Methods:** This qualitative study utilized phenomenography to capture and categorize variation in students’ experience of this pre-liminal state. A purposeful sample of dental hygiene students enrolled in a degree-completion program volunteered to participate in semi-structured individual interviews. Interview questions explored why they decided to undertake degree-completion studies, what factors influenced their decision, what their expectations were, and how they believed their expectations as a student might change. Qualitative coding utilizing phenomenographic analysis was conducted to determine the various ways in which students experience pre-liminality. Ethics approval was obtained from the University of Alberta Research Ethics Board (#Pro00072407). **Results:** Students articulated a variety of reasons for immediately pursuing their degree, including the short-term impact of an additional year of study, as well as long-term implications on their careers. However, students were unclear on the expectations, experiences, and cognitive adjustments necessary during this transition. **Conclusions:** Students entering the degreecompletion program do not seem aware of the possible cognitive adaptations that may be required to successfully navigate their new learning environment but can articulate a desire to earn a degree as part of their career goals. It is important to understand this pre-liminal state to implement strategies to support this transition for dental hygiene degree-completion students. Funding for this project was provided by the Summer Studentship in Health Professions Education (HPE) Grant Program — Office of Education, Faculty of Medicine and Dentistry, University of Alberta.

**Problem statement:** Since 1988, there has not been a Master of Science (MS) in Dental Hygiene (DH) program in New York State (NYS) to provide educational opportunities for professional growth and alternative employment settings for dental hygienists. **Purpose:** The purpose of the study was to assess the need to establish an MS in DH program in NYS, whose curriculum and design would meet the needs of DH graduates. **Methods:** A convenience sample of 5244 American Dental Hygienists Association members was used to complete a survey to assess the need, curriculum specialization, and educational design for an MS in DH degree curriculum. The survey contained 11 items with closed-ended responses. It was pilot tested by the DH Research Development Committee to establish content validity. The survey was administered online and all responses remained confidential. Descriptive statistics were used to analyse the data. No ethics approval was needed according to New York University’s IRB Office. **Results:** There were 828 (16%) respondents, 571 (69%) of whom are currently employed as dental hygienists: 696 (84%) in clinical, 232 (28%) in education, and 17 (2%) in sales and marketing. Reported highest degree earned were bachelor’s (43%), associate (35%), master’s (19%), and doctorate (3%). Interest in an MS program was reported by 24%, while 26% were undecided. Of the areas of degree specialization, 73% selected educational leadership, 65% chose advanced DH practitioner (ADHP), 39% selected clinical research, and 25% chose sales/business management. The preferred delivery of the curriculum was online, selected by 47%, while 46% preferred a hybrid, and 7% a traditional classroom setting. **Conclusions:** Currently there is no MS degree program in NYS. Survey results indicated that 199 (24%) were interested in earning a master’s degree. The majority of respondents supported the need for an online or hybrid program.

**Problem statement:** In order to effectively support students’ delivery of motivational interviewing (MI) during patient care, faculty should have appropriate training. **Purpose:** The purpose of this study was to assess the University of Michigan (U-M) Dental Hygiene (DH) faculty members’ perception of the importance of and their confidence in supporting students’ delivery of MI during patient care before and after participating in MI professional development activities. **Methods:** A convenience sample of 16 U-M DH program faculty members, who teach in clinic, participated in this study. They participated in MI training workshops focusing on increasing their understanding of MI, integrating this into their teaching, and supporting students’ application during clinical care. There were 4 evaluation instruments: 3 utilized a Likert scale pretest, post-test format; 1 used a qualitative question design. The U-M Institutional Review Board (IRB) approved this study as exempt (HUM00065102). **Results:** Wilcoxon signed ranked test compared importance and confidence in facilitation of MI strategies from T1 (pre-test to post-test 1), T2 (pre-test to post-test 2), and T3 (post-test 1 to post-test 2) and found no statistical significance. In addition, faculty perceptions increased (T1, p = 0.03) related to students having enough time to incorporate MI during patient care. There was a decrease (T3, p = 0.03) regarding faculty perceptions of having a positive influence on students’ application of MI strategies. Faculty perceptions of importance and confidence supporting students’ delivery of MI strategies decreased slightly without statistical significance. Fiftysix percent of faculty participated in team grading and reported that the most helpful professional development activities were team grading (58%) and in-service (25%). **Conclusions:** Faculty members’ perceptions of the importance of and their confidence in supporting students’ delivery of MI decreased slightly over the academic year. Faculty found professional development activities helpful and recommended that more be offered. Research on the longitudinal impact of MI faculty professional development is recommended. Funding for this project was provided by Rackham Block Grant Funding.

**Problem statement:** Research is a critical component of dental education. While it is accepted that most dental hygiene professional students initially enter practice, clinicians must have a basic understanding of research to support their clinical decision making. **Purpose:** The purpose of this project was to provide student dental hygienists with a hands-on opportunity to participate in a clinical research project to supplement their research course. **Methods:** Four dental hygiene programs identified a faculty member to serve as the principal investigator at each site. Students recruited 2 to 3 patient participants with moderate to poor oral hygiene, plaque accretions, and gingivitis for 2 visits. A plaque index, gingival index, percent bleeding on probing, and an oral soft tissue examination were collected. Students completed a subjective assessment questionnaire about each participant’s oral health and performed a dental prophylaxis. Participants were provided 2 tubes of Colgate® Total® toothpaste and a soft manual toothbrush. Home care instructions were provided. Follow-up evaluations scheduled 6 to 8 weeks later included recording oral health indices and a participant questionnaire. Students completed a questionnaire regarding observations made during the study. Ethics committee/IRB approval was secured at each institution prior to commencement of the study. **Results:** Over 100 students engaged a total of 298 participants. Clinical results demonstrated statistically significant (p < 0.05) reductions in plaque index (from 1.44 to 0.55), gingival inflammation (from 1.28 to 0.39) and bleeding on probing (from 31.29% to 8.04%). Principal investigators reported a high level of engagement, interest, and satisfaction among the students who participated as examiners in the study. **Conclusions:** This study demonstrated the positive effect that including students as examining clinicians in a clinical study can have on their understanding and appreciation of research and bringing discoveries to practice. Funding for this project was provided by Colgate-Palmolive, Co., Inc.

**Problem statement:** There is a scarcity of studies on Canadian baccalaureate dental hygienists. As discussions about baccalaureate education for dental hygiene continue on a national level, examining outcomes of earning a dental hygiene degree is paramount. **Purpose:** To investigate the practice outcomes of the University of British Columbia’s (UBC) Bachelor of Dental Science in Dental Hygiene (BDSc) graduates. **Methods:** UBC dental hygiene entry-to-practice (ETP) and degree-completion (DC) graduates (n = 116; 30% response rate) from 1994 to 2016 participated in an online survey. Survey questions explored motivating reasons for pursuing dental hygiene degree education, abilities gained during their degree, and practice outcomes after earning their degree. Chi-squared tests were used to compare ETP and DC graduates. Survey results were also compared to the Canadian Dental Hygienists Association (CDHA) national job market and employment survey. Ethics approval was received from UBC’s Behavioural Research Ethics Board. **Results:** Primary reasons for pursuing a degree were personal satisfaction (82%), increased knowledge base (82%), increased employment opportunities (78%), status/recognition of a degree (76%), access to graduate education (68%), and improved critical thinking abilities (61%). For DC graduates, abilities strengthened included enhanced skills for appraising research (92%), enhanced critical thinking and problem solving skills (90%), enhanced skills for retrieving scientific information (89%), and increased value for lifelong learning (85%). Respondents reported that the BDSc degree enabled them to expand their career opportunities (75%). More than 30% of respondents have pursued graduate education, and 40% work in employment settings outside of clinical practice. In comparison to CDHA’s job market and employment survey, a greater proportion of UBC BDSc graduates earn more than $80,000 annually (44% vs 16%, p < 0.001), receive more benefits (4.0 vs 3.5, p < 0.001), and collaborate more with non-dental health professionals (2.7 vs 0.8, p < 0.001). **Conclusion:** The results highlight the impact of UBC baccalaureate education on dental hygiene practice.

**Problem statement:** Today’s collaborative health care system calls for dental hygiene academia to adopt interprofessional education (IPE). The commencement of such transformative initiatives is the responsibility of administrators and faculty. However, their viewpoints can prevent the progression of these strategies. Failure to foster IPE can potentially jeopardize the relevance of the profession. **Purpose:** The purpose of this study was to assess the attitudes of dental hygiene administrators and faculty towards IPE, and to investigate how perspectives influence the implementation of this educational methodology. **Methods:** This quantitative cross-sectional study utilized a snowball and convenience sample of 91 dental hygiene administrators and faculty who completed a survey about viewpoints towards IPE and the use of interprofessional practices. The survey consisted of 34 items with closed-ended responses. Of these items, 28 were adapted with permission and were previously content validated. Survey data were collected through the use of an online software application. All responses remained anonymous and confidential. Descriptive and inferential statistics were used to analyse the data. IRB approval was obtained from Farmingdale State College. **Results:** Respondents demonstrated favourability towards interprofessional education (M > 3.00 for 26 of 28 items). Approximately half (47.78%) of them were in the infancy stages of integrating IPE into curricula, while only 5.56% had incorporated it as a major component. There was a significant association between attitudes and use of IPE (rs = 0.269), which highlighted student comprehension, course quality, and logistics (p = 0.05). **Conclusions:** Although administrators and faculty do hold IPE in high regard, most affiliated programs are not structured on interprofessional models. Perspectives have instilled a desire to develop and implement transformative plans focused on incorporating shared teaching and learning into dental hygiene education. Favourable attitudes are impacting the evolution of collaborative educational opportunities contributing to dental hygiene students becoming a part of modern medical practices.

**Purpose/Goals:** The program goals were to provide oral screenings, patient education, and preventive oral health services to children through a collaborative, interprofessional community outreach program. The purpose was to target children in communities without access to oral health care, provide dental hygiene students the opportunity to participate in a valuable community outreach program while honing clinical skills in the dental hygiene care of children and adolescents. **Significance:** This program provided preventive services to underserved children while incorporating an educational component for patients and students with an interprofessional element to enhance the program through health care disciplines. **Approach:** Sophomore dental hygiene students provided oral health care, freshman dental hygiene students volunteered as assistants, dental residents provided urgent care while dental hygiene faculty and dentists from neighbouring dental societies supervised the clinic floor. Speech pathologists distributed information to attendees, nursing faculty and students provided blood pressure screenings, and medical laboratory technology faculty and students demonstrated proper handwashing techniques. Representatives from oral health and health care companies disseminated information. Appointments were scheduled, and children were accompanied by a parent or guardian on the day of the event. Sophomore dental hygiene students reviewed health histories, obtained consent forms, completed oral health screenings, patient education, oral prophylaxes, and fluoride varnish. Dental sealants, when deemed necessary, were provided. Dental hygiene faculty and supervising dentists reviewed student findings and signed the completed screening forms. **Evaluation:** Data analysis supported the intended goals in the need for community outreach programs. Post-event data indicated 187 screenings, 180 prophylaxes, and 150 fluoride varnishes were provided while 146 dental sealants were placed and 2 children received urgent care. All children and parents participated in the patient education program. Of the 187 children treated at the events, 66.13% presented with decay and 9.60% presented with recurrent decay. This collaborative, interprofessional program for community outreach supports reducing health disparities in preventive dental hygiene care.

**Problem statement:** Patients who lack a dental home consult pharmacists about oral health information and advice. **Purpose:** The purpose of this study was to evaluate the impact of an interprofessional training program on practising pharmacists’ knowledge, confidence, and perceived preparedness to counsel older adults about oral health. **Methods:** A convenience sample (n = 63) of practising community-based pharmacists was recruited to attend a training program about oral health, and 44 chose to participate. Prior to the program, 41 (93%) completed 2 surveys: one assessing experiences and training related to oral health, the other a pretest to measure knowledge, ability, and level of preparedness with counseling older adults. Immediately after training, participants completed the matching post-test. Responses were anonymous to protect confidentiality. Data were analysed using SPSS 22 (IBM Corp. Armonk, NY). AT Still IRB approved the study (#2015-068). **Results:** The most frequent oral problem about which pharmacists’ advice was sought was mouth ulcers (n = 10; 24%). Pharmacists perceive dry mouth as the most important oral health problem among older adults (n = 11; 27%). An exact McNemar’s test determined that there was a statistically significant difference on 5 of the 12 knowledge measures (p = 0.000) after the training intervention. A Wilcoxon signed-rank test showed that participation in the training program produced a statistically significant change in pharmacists’ confidence in ability to locate oral health information (Z = –4.730, p = 0.000) and available area dental resources (Z = –4.350, p = 0.000); and level of preparedness to counsel older adults about the importance of oral health to overall general systemic health (Z= –4.638, p = 0.000) and about interventions to address oral health needs (Z = –5.066, p = 0.000). **Conclusions:** Participation in an interprofessional training program improved pharmacists’ knowledge, confidence in their ability to locate resources, and level of preparedness to counsel older adults about oral health. Funding for this project was provided by the Dental Trade Alliance Foundation.

**Problem statement:** Australian oral health practitioners (oral health therapists [OHT], dental hygienists [DH], and dental therapists [DT]) work autonomously within their scope of practice in a structured professional relationship with a dentist. There is no requirement for standing orders or supervision of practice. How this relationship plays out in practice and the nature of vertical relationships within the dental team can affect cost and access to dental care. **Purpose:** To describe the interprofessional relationship between oral health practitioners and dentists. **Methods:** Following ethics approval from the University of Adelaide, a survey mailed to all members of the 2 professional associations representing DT, DH, and OHT collected practitioner and clinic characteristics. Practitioners described the frequency (7-point Likert scale) with which they prepared treatment plans, consulted a dentist prior to providing treatment, and how often treatments provided were inspected by a dentist. Associations between a range of characteristics and the frequency of these activities were assessed by comparing proportions (Chi-square, p > 0.05). **Results:** Overall response rate was 60.6% (n = 1083); 28% were registered as DT, 29% as OHT, and 43% as DH. Among the 3 practitioner groups, DT had the highest proportion (78.6%) reporting that they very often or always prepared patient treatment plans, and the lowest proportion (16.2%) very often or always consulted a dentist and inspection by a dentist (9.2%). By contrast, DH reported the lowest proportion (41.6%) very often or always prepared patient treatment plans, and the highest proportion (41.6%) very often or always consulted a dentist and inspection by a dentist (36.4%). Self-reported frequency of these activities significantly varied by a range of practitioner and clinic characteristics. **Conclusions:** The nature of interprofessional relationships varied by practitioner type and clinical setting. Education of oral health practitioners and dentists should include the development of effective working relationships. Further research should investigate the impact of professional relationships on costs of care, applied practice scope, and patient outcomes. Funding for this project was provided by the National Health and Medical Research Centre (NHMRC) Centres for Research Excellence (Grant no. 1031310).

**Problem statement:** Performing preventive oral screenings can reduce the “silent epidemic” of early childhood caries. Although nurses working in pediatric settings can assist in preventive dental care, many report having insufficient skills to perform such tasks. **Purpose:** The purpose of this study was to improve nurses’ pediatric oral health knowledge and practices through a theorybased educational intervention. **Methods:** This randomized control trial used a sample of 33 nurses. Using the random number generator software, 18 participants were assigned to the intervention group, and 15 to the control group. Data collection for the study occurred over a 4-week period. An adapted, validated 21-question survey designed through Qualtrics© software measured oral health practices at pre and post-test. The electronically delivered continuing education (CE) course focused on children’s oral health. Participants in the intervention group received the CE course immediately following completion of the pretest survey whereas participants in the control group received the CE course content after completing the postsurvey at 4 weeks. A trivia question related to children’s oral health was delivered via email at 3 weeks to keep all participants engaged over the 4 weeks. Participants who completed all portions of the study received 1 free CE credit as an incentive for participating in study. The IRB at Old Dominion University approved this study. **Results:** There was no significant difference between control and experimental groups at pre- and post-test for performing OHAs on children, F (1, 30) = 1.70, p = 0.20. The following scores significantly increased from pre- to post-test within experimental and control groups: knowledge (F [1, 31] = 12.67, p = 0.001), confidence performing OHAs (F [1, 30] =10.17, p = 0.003), and confidence providing anticipatory guidance to parents (F [1, 30] = 10.78, p = 0.003). **Conclusions:** Due to small final sample size, a post hoc power analysis determined a minimum final sample of 61 is needed for future studies to observe differences between groups. However, improvements in knowledge, confidence performing OHAs, and providing anticipatory guidance to parents were observed within groups.

**Purpose:** In 2015, a university dental hygiene program implemented an interprofessional education experience. The purpose was to give students a broader understanding of their scope of practice and collaboration with all relevant health care providers for the delivery of patientcentred interprofessional, collaborative care. Significance: This novel curricular educational experience prepares health profession students for deliberatively working together with the common goal of building a safer and better patient-centred and community- or populationoriented US health care system. **Approach:** Applying adult learning theory, students were put into groups, given one of several case scenarios, and asked to design an interprofessional collaborative care model. Students were asked to answer questions in a paper pertaining to: 1) prior interprofessional collaboration knowledge; 2) medical, dental, and psychological conditions of the patient in the case scenario; 3) team member roles and responsibilities; 4) rationale for their particular model; and 5) potential benefits and challenges. A rubric was provided for quantitative evaluation by a dental hygiene faculty member to grade student models and papers. Qualitative feedback was evaluated by content analysis of openended discussion in the papers. **Evaluation:** Sixty-four of 82 students stated that they did not know much about interprofessional collaboration (IPC) prior to this curricular experience. Grades for demonstrating application of IPC knowledge ranged from 90% to 100% with a mean of 97.3%. Additionally, each group uniquely and creatively depicted an interprofessional model using a poster board, a computer image or a hand-crafted 3D model. Some narrative highlights from discussion papers include “it is important to engage peers, communicate and correct behaviours for patient centrred care” and “research will continue to grow, but making sure to collaborate with one another will only speed up the process.”

**Purpose:** The practice standard of "collaborate with others" requires prelicensure programs to prepare students to be entry-to-practice competent interprofessional collaborative care (IPCC) practitioners. This is a must for program accreditation and a must from a health care perspective. The Rady Faculty of Health Sciences, University of Manitoba (RFHS/UM) offers 9 prelicensure programs through the Colleges of Dentistry (CoD), Medicine (CoM), Nursing (CoN), Pharmacy (CoP), and Rehabilitative Sciences (CoRS) as follows: dentistry, dental hygiene, physician assistant, physiotherapy, occupational therapy, respiratory therapy, medicine, nursing, and pharmacy. The RFHS/UM established the Office of Interprofessional Collaboration (OIPC) with one IPCC academic/scholar from each of the 5 colleges. The purpose of the OIPC was to create a longitudinal undergraduate IPCC curriculum in which students from all 9 programs learn about, with, and from each other. Along with creation comes evaluation; hence the OIPC maintained both formative and summative evaluation throughout the iterative development and delivery of year 1 of the 2-year didactic curriculum. **Significance:** If health care providers are expected to be IPCC practitioners then curricula should be designed to best prepare them for this role. **Approach/Key features:** The OIPC curriculum is informed by 2 models: Stark and Lattuca's Academic Plan and D'Amour and Onandasan's IPE/IPC model. Mixed methodology was used to evaluate the first-year delivery. College councils, dialogue with community leads, curriculum retreats, surveys, and student focus groups are examples of data gathering methods. **Evaluation:** Year 1 of the curriculum involved 52 first­ year student IPCC learning cohorts (>950/o participation rate). Respective college curricula councils enabled cohorts to participate, per term, in 1 face-to-face simulation­ based facilitated session, 2 online guided discussions, 1 assignment, and 1 reflection. Focus groups and survey responses indicate the curricula helped students understand the importance of IPCC to future practice and that authenticity and meaningful learning are critical to IPCC curricula. Funding for this project was provided by Rady Faculty of Health Sciences, University of Manitoba.

**Problem statement:** Communities across Canada are revisiting their community water fluoridation (CWF) status, with some opting to discontinue. Understanding the impact of CWF cessation on children’s dental caries requires consideration of other possible changes that may also impact children’s caries rates. One such factor is practice adaptations by dental hygienists, perhaps undertaken in an effort to offset an anticipated impact of fluoridation cessation. **Purpose:** To examine whether, or the extent to which, dental hygienists in Alberta engaged in practice adaptations according to the CWF status of the community in which they work. **Methods:** All dental hygienists in Alberta were invited to complete an online questionnaire asking about changes to their dental hygiene practice since CWF cessation or, for those in noncessation communities, during a similar timeframe. Reported practice adaptions were compared between those working in CWF cessation communities versus still-fluoridated communities using chi-square analysis. The University of Calgary’s Conjoint Health Research Ethics Board approved the study. **Results:** A total of 154 dental hygienists provided information on practice adaptations. Compared to dental hygienists working in still-fluoridated communities, those working in CWF cessation communities were: 1) more likely to report increasing recommendations for more frequent in-office fluoride treatments (e.g., fluoride gel) (p = 0.03); and 2) less likely to report decreasing recommendations for more frequent radiographs (x-rays) to detect decay (p = 0.03). There were no differences between the 2 groups on attitudes towards CWF, a potential confounder. **Conclusions:** CWF cessation appears to be occurring more frequently in Alberta and elsewhere. Research on CWF cessation and its implications for population oral health is complex, and must consider other factors (aside from CWF cessation) that may have changed during the same time. This study found that dental hygienists report having adapted their practice regarding recommendations for frequency of in-office fluoride treatments and dental radiographs. Funding for this project was provided by Dr. Lindsay McLaren’s Applied Public Health Chair award (http://www.cihr-irsc.gc.ca/e/49128. html), which is funded by the Canadian Institutes of Health Research (Institute of Population & Public Health and Institute of Musculoskeletal Health & Arthritis).

**Problem statement:** Community oral hygiene services for non-invasive periodontal dental care can be applied as a community program to people with hypertension and diabetes. **Purpose:** This study aimed to evaluate the effects of a community-based oral hygiene service for patients with hypertension and type 2 diabetes mellitus in Korea. Methods: The study used a 1-group pretest-posttest and interrupted time-series design and lasted 8 months. A total of 151 participants (45% male and 55% female, 63±8.4 years) were included in the study. Participants included patients with hypertension (62%), diabetes (12%), and both (26%). The objective oral hygiene and subjective selfreported periodontal status were compared before and after the study. Changes in HbA1c levels from the first and last visits were analysed using the paired t-test. Blood pressure and objective periodontal status were analysed using repeated measures ANOVA to evaluate changes. Subjective periodontal status was evaluated using a chi-square test. All analyses were performed using SPSS 21 (Chicago, IL). This study was approved by the IRB of Wonju College of Medicine, Yonsei University (YWDR-15-2-027). **Results:** Participants maintained stable blood pressure at each of the 4 sessions, and their HbA1c levels were significantly lower at the fourth session (p < 0.05). A lower frequency of subjective swelling was reported at the fourth (37.9%) compared to the first (55.6%) session. Further, significantly fewer cases of calculus and bleeding were observed at the fourth session (p < 0.05), and significantly more patients reported having no gum problems at the fourth session (43.1% vs 27.2%; p < 0.05) than the first session. **Conclusions:** Community oral hygiene services reduced plaque scores and led to self-perceived improvements in symptoms of gum swelling and bleeding. Findings indicate that community oral hygiene services provided by dental hygienists can promote periodontal health, and may help in the management of hypertension and diabetes.

**Problem statement:** Because oral health is fundamental to maintaining overall health, all people should be granted access to oral health care. A lack of access to oral health care exists among vulnerable and underserved populations in the United States. **Purpose:** The purpose of this study was to evaluate a program in which patients volunteer in their community in exchange for receiving no-cost dental care. The motivations, attitudes, and perceptions of the participating patients and volunteer dentists were assessed. **Methods:** This cross-sectional study obtained background information from 66 adults originally interested in this program. Survey data were received from 27 of 38 patient participants and 10 of 11 dental participants, including demographics, dental treatment received or provided, experiences with the program/volunteering, and recommendations for program improvement. Volunteer dentists received no incentive for program participation. The IRB at the University of Michigan determined this study was exempt from oversight. **Results:** Types of treatment provided by volunteer dentists as part of the Pay It Forward Program included non-urgent services such as oral hygiene education, examination, radiographs, prophylaxis, scaling and root planing, extractions, and simple restorations. The average dollar amount of services provided to each patient was $1,153. Pain was the main motivating factor for 70% of the patients who sought treatment. Patients volunteered an average of 33 hours. Patients reported significant oral health improvements from before (very good/excellent 4%) to after program involvement (very good/excellent 44%). The majority of patients and dentists rated the program and all of its aspects very positively. There were no statistically significant differences between those who enrolled in the program and those who did not enroll in relation to age, household income or distance from the program. **Conclusions:** Innovative efforts to increase access to oral health care for underserved and uninsured adults should be explored in addition to advocating for policy changes. Funding for this project was provided by the University of Michigan Rackham Graduate Student Research Grant and the Rackham Block Grant Award.

**Purpose:** The University of Manitoba pledges to contribute to the cultural, social, and economic wellbeing of Manitobans. Canada received over 300,000 new permanent residents in 2016. Half arrived through economic immigration programs and approximately 60,000 came as refugees. The School of Dental Hygiene (SDH) aims to create culturally responsive care curricula, meet community needs, and ensure dental hygiene care plans (DHCP) reflect community- and person-centred needs. **Significance:** Manitoba received the third largest influx of newcomers. Though immigrants in general experience good health, refugees do not and often have a much lower health status reflective of trauma, malnutrition, and infectious disease. Many have not benefited from oral health care. A key determinant of health is health care (HC) services. Many HC providers lack cultural proficiency and are not prepared for the cultural diversity of the population. Health beliefs and practices are culturally informed. Lacking the understanding of these from a practitioner perspective results in poor person-centred care plans. Both prelicensure and professional development curricula must ensure HC practitioners enable, advocate, and promote health for all. **Approach/Key features:** Four steps were taken to incorporate minimal cultural competence within the prelicensure curriculum as follows: 1) collaborate with primary HC clinics serving newcomers to offer DH care (DHC); 2) establish a Smiles for Miles donation fund to cover the cost of DHC for newcomers via the SDH clinic; 3) develop a curriculum that results in culturally reflective DHCP; 4) explore formative and summative client feedback mechanisms. **Evaluation:** Since February 2016, 22 newcomers received DHC thanks to $8,000 in donations from the community and industry. Program viability has been established. Measures of client satisfaction are promising based on return rates. A major student theme was heightened awareness of needs of newcomers. Curriculum planning is in progress to weave theory with practice to promote culturally responsive care.

**Purpose:** College of Dentistry, School of Dental Hygiene, University of Manitoba collaborates with the Diabetes Education Resource for Children and Adolescents (DERCA) interprofessional collaborative (IPC) team. Dental hygiene (DH) services are provided as part of the education and surveillance of the youth at the DER-CA type 2 diabetes clinic. The majority of children followed in this program are of self-declared First Nation heritage. The first 3 cycles of the Plan-Do-Study-Act (PDSA) Model for Improvement moved the collaboration from a prelicensure DH student rotation to Bachelor of Science IPC service learning (SL) for a registered DH. The goal was to promote IPC dialogue regarding youth oral health and type 2 diabetes management. Significance: There is limited knowledge and research involving youth with type 2 diabetes and their oral health. Incorporating a DH assessment has helped the IPC team consider oral–systemic health within the care plan. **Approach/Key features:** A fourth PDSA cycle responded to 3 questions pertaining to what, how, and how will you know as follows: 1) advance contribution of DH as part of the IPC team; 2) incorporate DH findings within the electronic record; and 3) DH participation in IPC team dialogue. The PDSA involved creation and implementation of a DH assessment template, participation in the IPC team preclinic meetings, oral health assessments and information sessions for the youth, and scheduling of IPC dialogue regarding DH findings to the IPC team. **Evaluation:** The PDSA resulted in DH weekly participation in IPC dialogue and the incorporation of the DH assessment within the electronic record. Future PDSA cycles are underway to evolve the SL to a DH independent practice within an IPC team. Access to DH care remains an issue for various ethnic youth. Programs such as the DERCA promote the need for DH care as part of the youths’ overall health.

**Objective:** The Canadian Dental Hygienists Association, Canadian Dental Association, and Canadian Pediatric Society advise that children should see a dental professional no later than age 1. The dental home model is based on the concept of developing an ongoing relationship between the practitioner and patient where oral health care is delivered in a comprehensive, continually accessible, coordinated, and family-centred way. This scoping review examined literature on the effectiveness of early pediatric dental homes based on clinical, behavioural, and cost parameters. **Search strategy/Selection criteria:** Seven key databases (MEDLINE-Ovid, PubMed, CINAHL, Embase, Cochrane Database of Systematic Reviews, Scopus, and BioMed Central) were searched using “dental home” and “dental homes” as key words. No limits were placed on the search strategy. Searches were conducted up to and including April 2016. Criteria for inclusion were studies that had examined preschool-aged populations and had focused on parameters to assess effectiveness of dental homes. **Data collection and analysis:** In total, 232 non-duplicate citations were identified for title and abstract review, of which 7 articles met the inclusion criteria and were included in the final analysis. Data extraction and synthesis were completed by the first author and verified by the co-author. Main results: Six primary studies and one systematic review were included in the final data set. Current evidence generally supports the effectiveness of early pediatric dental homes for improving clinical outcomes (i.e., dmft scores) and behavioural outcomes (i.e., including utilization of future dental care services), and offering potential cost benefits. However, exact quantifications of the impact on clinical and behavioural outcomes as well as cost benefits vary due to heterogeneity of study design and methodological considerations related to level of evidence in the studies. **Conclusions:** The current body of evidence predominately substantiates the establishment of a dental home model as an effective practice to improve early pediatric oral health.

**Problem statement:** Little is known about the pattern of dental services utilization among adults with diabetes. **Purpose:** The purpose of this study was to assess factors that predict the likelihood of adults with diabetes using preventive and emergency dental services. **Methods:** A cross-sectional study was conducted, using the Andersen and Newman Framework of Health Services Utilization dimensions (predisposing, enabling, and illness variables) to predict dental service utilization using 2001–2002 NHANES dataset, which was the last year of dental service usage inclusion. The target population was US adults, 18 years of age or older; n = 4707 based on inclusion/ exclusion criteria. Statistical Analysis Software (SAS®) was utilized to accommodate the NHANES sampling design and weights. Data analysis was achieved using chi-square and multinomial logistic regression with a hierarchical (blockwise) entry of predictor variables. This study has IRB approval (number 757668-1). **Results:** Results reveal that individuals with diabetes were significantly (p = 0.0002) less likely to utilize dental services in the past 12 months compared to individuals without diabetes. Based on odds ratios, significant predictors in the preventive service utilization model were gender, marital status, age, education, income, regular source of care, dental insurance, self-reported pain, and recommended care based on oral exam findings. Significant predictors in the emergency service utilization model were unmarried status, age, education, regular source of care, dental insurance, selfreported painful tooth, and recommended care based upon oral exam findings. **Conclusions:** Diabetes status is a significant predictor of not having a preventive dental visit, even after controlling for age, gender, marital status, income, race/ethnicity, and education based on the results. These findings are a concern given the evidence supporting integrating oral health with diabetes management care. Further research is needed to compare results with current dental visits by individuals with diabetes.

**Problem statement:** Dental caries continues to be the most chronic childhood disease, and treatment of this disease is the most common day surgery for children in Canada. Oral disease is experienced most by socioeconomically disadvantaged individuals. It is recommended that children first visit a dental professional by age 1. **Purpose:** The research objectives were to examine the utilization of oral health care services by children with unmet dental needs and to determine the caregiver’s perception and utilization of the oral health care system in Nova Scotia. **Methods:** This study utilized a cross-sectional design. A questionnaire based on the Framework for the Access to Care was given to caregivers (n = 62) of children undergoing dental treatment at the Izaak Walton Killam Health Centre. **Results:** Less than a quarter (23%) of the children visited a dentist by the recommended age of 1ne. The mean age that caregivers perceived to be the recommended age of first visit was 2.29. The mean age that caregivers first sought dental care for their children was 2.69. Forty-four percent of children had caries at that time. Alternate dental care settings were preferred by over half (51%) of caregivers for children’s dental care. There was an overrepresentation of Aboriginal children (10%); low-educated caregivers (41.2%); and families from rural communities (50.4%) and low-income threshold (53.8%). **Conclusions:** This study supports current evidence that socioeconomically disadvantaged individuals are vulnerable to oral diseases. The ability to offer services in settings that are easily accessed by vulnerable populations, such as community and school-based clinics and primary care settings, influences preventive outcomes. Utilizing dental hygienists, dental therapists, and primary care providers in alternate practice settings should be considered. This research study received ethics approval from Athabasca University REB #22011 and the IWK Health Centre REB# 1021493).

**Problem statement:** Despite improvements in oral health status in recent decades, dental decay is still the most common preventable childhood disease worldwide. **Purpose:** To investigate whether providing an oral health educational intervention results in improvements in oral health knowledge among pre and postnatal parents and caregivers, and to explore the motivations and attitudes of parents towards oral health (REB#2015-093). **Methods:** A mixed-methods design included pre and postintervention components and a semistructured interview. In Phase I, participants attended an oral health education session where oral health knowledge and attitudes were assessed prior to and immediately following the education session. In Phase II, participants were offered a free dental debridement; they participated in a brief semistructured interview regarding their oral health motivations and behaviours and completed a second postquestionnaire on oral health knowledge and attitudes. **Results:** Thirtythree participants attended the oral health education sessions and completed Phase I; of those, 5 chose to complete Phase II. The education session was effective at improving participants’ total knowledge scores. Scores on 13 questions increased significantly, from 7.70±2.64 (mean±SD) (median 7) before the education session, to 11.24 ±2.27 (mean±SD) (median 12), immediately after the session (p < 0.001). This knowledge was retained into Phase II. Despite the limited number of participants, 4 overall themes emerged: 1) participants are knowledgeable about the importance of oral health; 2) they believe their teeth and their children’s teeth are important; 3) knowledge provides minimal increases to motivation and attitude change; and 4) factors such as income, education, and social support influence the adoption of positive oral health behaviours. **Conclusions:** Oral health education is successful at increasing parents’ knowledge; however, new research on clinician techniques and strategies that address the social determinants of health are needed to improve parent and patient motivations towards improved oral health behaviours.

**New programs:** The purpose of this study is the collaboration between STOHN and The Tooth Fairy Project to collect deciduous teeth for analysis and increase knowledge and awareness of practitioners to grow their confidence in educating their patient population about potential environmental exposure risks. This collaboration between medicine and dentistry provides emerging science to dental practitioners; an important process in engaging families in discussions about environmental exposures. The goal is to enroll 10 dentists, each enrolling 20 parents. **Significance:** Neurodevelopmental disorders (ND), such as autism spectrum disorder (ASD), affect 1 in 68 births. Previous studies show that awareness of exposure risk during pregnancy in South Texas is low. Therefore, it is important to increase provider knowledge and awareness to enable greater communication with their patients. Local practice-based research networks in South Texas are important communities that potentially impact large numbers of patients. This study engages practitioners in an ongoing national study with minimal impact on their practice. **Approach/Key features:** Enrollment is through use of continuous recruitment of STOHN members and referred general and pediatric offices. Practitioners are contacted by phone and in person. Upon completion of Human Subject Protection training, each office is provided a training manual and "lunch-and-learn" education on ND and environmental exposure. They are trained in engaging their patients, provided prepaid packaging for donated teeth, and supported in survey completion. Lists of interested patients are generated and used to contact them by the study coordinator. Each child who donates will receive a personalized thank you letter from the Tooth Fairy. Providers are highlighted for their participation in our monthly newsletter. **Evaluation:** Evaluation is threefold: Practitioner enrollment and retention success and difficulties; survey of increased knowledge, awareness and improved attitude about communicating risks to their patients; and number of completed surveys submitted with donation of teeth. UTHSCSA IRB Protocol # HSC20170132E.

**Problem statement:** Strong evidence links a mother’s oral health to her children’s caries experience when living in non-mobile environments. Yet a pilot study indicated that this relationship is disrupted when families are forced to migrate. **Purpose:** This study was conducted to further test the correlation of mother–child caries in multiple Somali day care centres, and to assess social determinants of health associated with child caries experience. **Methods:** Somaliaborn mothers and their dentate children up to age 12 years enrolled at Somali day care facilities located in Minnesota were eligible for the study approved by the University of Minnesota IRB. Clinical screenings provided the dependent variables of dmfs and DMFS counts. Independent variables were gained through face-to-face surveys, with mothers recording demographic information, mother’s oral health knowledge (KOCH index), beliefs, fatalism (OHF), behaviours, and neighborhood characteristics. Data analyses included descriptive statistics, Spearman’s correlation, and linear mixed effects models adjusting for maternal and child age, and mother’s education, age at migration, and years lived in the US. **Results:** Data were collected from 98 mothers and 294 children at 9 sites. The mean age was 34.0 years for mothers and 7.8 years for children. No correlation was found between mother and children’s primary (r = 0.16, p = 0.23) or permanent (r = –0.17, p = 0.78) caries experience. Statistical significance was found between child dmfs and mother’s knowledge of the purpose of fluoride (p < 0.01) and family’s main drinking water source (p < 0.05); and between child DMFS and mother’s likelihood of returning consent forms to child’s school (p < 0.0001). **Conclusions:** Preliminary results indicated that clinicians’ previously accepted knowledge that mothers and their children have similar caries experience is questionable when applied to those subjected to forced migration (e.g., refugees). Factors related to the knowledge and consumption of fluoride and written parental consent to participate in school-based sealant programs were related to child caries experience.

**Problem statement:** Globally, interest in independent dental hygiene practice has been increasing. However, in Korea, dental hygienists are only allowed to practise under the direct supervision of a dentist, and the number of public dentists has decreased. This decrease in available supervising dentists has made it difficult to practice public dental hygiene. Further, the supervision requirement does not allow for independent dental hygiene practice. Interest for independent public dental hygiene practice is unknown. **Purpose:** The purpose of this study was to identify the demand for public dental hygienists to practise independently and the scope of services provided. **Methods:** A survey was sent to 159 Korean public dental hygienists who were randomly sampled from the 1531 Korean public dental hygienists. All participants provided written informed consent. Questions on the survey assessed the need for independent practice of public hygienist duties in 2 categories: public oral health and preventive dental treatment. Participants were asked to select the following options for each task: direct supervision, indirect supervision or independent dental hygiene practice (IRB No. CR317015 by Yonsei University). **Results:** Public dental hygienists were very interested in both independent public oral health practice and preventive dental treatment. Identified high-demand services in public oral health practice included oral health education, fluoride mouth rinsing, and oral health project-related administrative services. In preventive dental treatment, high-demand services included toothbrushing instruction and use of oral care devices. Public dental hygienists were very interested in independent performance of oral health education, fluoride mouth rinsing projects, and instruction about toothbrushing and oral care devices. **Conclusions:** Public dental hygienists in Korea are interested in practising independently to provide oral health education, including oral care instructions, and fluoride mouth rinsing projects. This study was supported by the Korea Society of Public Health Dental Hygienists (2016-02).

**Goals:** Bridge to Health Medical and Dental, a Canadian humanitarian organization, has built a partnership with a local not-for-profit health care organization. Collectively, we conduct outreach missions to underserved communities and provide medical and dental care, improve health care delivery systems, train local health care workers, and educate the residents of these communities. Oral prophylaxis, composite restorations, extractions, and dentures are provided; however, our focus is on education, prevention, and sustainability. **Significance:** Greater than 50% percent of the population in rural southern Uganda suffer from oral diseases impacting their overall health, largely preventable with education and proper dental hygiene. In addition, remote villages are hindered by extreme financial barriers and access to care. **Approach/Key issue:** Our mobile team collected and analysed qualitative and quantitative data from remote villages. Decay rates and severity, acid erosion, calculus formation, and gingival inflammation were documented on school-aged children segregated by village and gender. In addition, villagers were questioned on what they grow and eat. **Evaluation:** Gross rampant decay rates upwards of 98% were linked to villages cultivating sugar cane. Decay rates of 63% with severe acid erosion were found in villages producing pineapple crops. Moderate alkalinity from Irish potatoes and sweet potatoes leads to heavy calculus formation and gingival inflammation. The neutral pH combination found in a village growing bananas and potatoes proved to have the lowest decay rate at 36% combined with the least amount of calculus and gingival inflammation. While efforts must continue to focus on education, it is imperative to include diet along with oral hygiene instructions. Further collaboration with medical providers linking diet, systemic disorders, and oral conditions supports enhanced interventions.

**Problem statement:** Dental therapy legislation in Minnesota was based on the premise that a differently constituted dental workforce would extend primary oral health services to underinsured and underserved populations. The first cohort of dental therapists (DT) began practicing in 2012, yet little is known about how this provider is used in practice. **Purpose:** The purpose of this descriptive study was to obtain baseline knowledge of dental therapists’ practice patterns in Minnesota. **Methods:** Four dental practices were sampled purposefully to obtain various practice types and geographic locations in Minnesota. Secondary data were collected from software databases in each practice between January and March 2015. Data were used to describe employment characteristics, types of patients seen, and applied scope of practice of dental therapists. Data 6 months pre and postemployment of the DT were collected to determine if dentists’ practice patterns changed after a DT was employed. Categorical variables and dental procedure categories were reported using frequencies and percentages. Work undertaken by the dentist pre and postemployment of the DT was tested within each dental practice for a total of 4 chi-square tests. A Bonferroni correction was used to account for the multiple testing (p = 0.0125). This study was deemed exempt from IRB review by AT Still University, Arizona IRB Committee (IRB # 2014-174). **Results:** Dental therapists were employed full time and saw an average of 6.8 patients per day, 90% of whom were uninsured or on public assistance. Restorative services comprised 68% of work undertaken. Dentists delegated a full range of procedures within the dental therapy scope of practice indicating trust and acceptance of the DT. Dentists in 2 practices began to take on more complex dental procedures after a DT joined the practice. **Conclusion:** Dental therapists are expanding access to dental care in rural and metropolitan areas of Minnesota.

**Problem statement:** As the US faces an increasing demand for oral health care, many states are examining alternative provider models and the role of the dental hygienist to meet their access to care crisis. **Purpose:** The purpose of this study was to assess Oregon dental hygienists’ opinions on scope of practice limitations and perceived need for a midlevel provider in Oregon. **Methods:** A survey was mailed in December 2013 to a 30% (n = 1231) sample of Oregon dental hygienists (DHs), which included all expanded practice permit (EPP) holders (n = 351). All other survey recipients were randomly selected from the total 4101 registered DHs in Oregon. The 32-question survey assessed scope of practice, midlevel provider, current practice, and demographics. A total of 444 surveys were returned (response rate of 36%). The study was approved by the Pacific University IRB. **Results:** Over half (59%) of DHs surveyed believe a midlevel provider is needed in Oregon. EPP holders and members of the American Dental Hygienists’ Association (ADHA) were significantly more likely to believe a midlevel provider was needed (p < 0.0001). Ninety-one percent (n = 400) of respondents agreed or strongly agreed that if a midlevel provider were introduced in Oregon it should be a registered dental hygienist. Forty-three percent (n = 186) of respondents were interested in becoming midlevel providers, and 47% of respondents (n = 203) believed the education for a midlevel provider should consist of training ending in a bachelor’s degree. The majority of those interested in becoming a midlevel provider (74%, n = 137) prefer to gain their education through online teaching with a clinical internship. **Conclusions:** DHs in Oregon believe there is a need for a midlevel dental provider and that this provider should be a registered dental hygienist. Those interested in developing a curriculum for a midlevel provider should consider including online teaching with a clinical internship component. Funding for this project was provided by a Legislative Grant from the ADHA.

**Problem statement:** To address the oral health access crisis, the State of Maine has enacted independent practice dental hygiene, public health supervision, expanded function dental auxiliary (EFDA) for registered dental hygienists and Dental Assisting National Board Certified dental assistants (CDAs), and most recently the dental hygiene therapist (DHT). Limited assessment has been conducted on the effectiveness of any of the workforce models. **Purpose:** The purpose of the study was to assess a) the implementation of EFDAs in dental practices; b) geographic practice patterns of EFDAs regarding at-risk and underserved populations; and c) EFDA attitudes regarding preparatory and continuing education. **Methods:** The study was deemed exempt by the University of Michigan IRB (HUM00121000). A 20-question survey was sent both via email and traditional mail to all 73 licensed EFDAs in Maine. SPSS software was used for analysis. **Results:** A response rate of 59% (n = 43) was achieved. Only 12% of respondents practised in a community or public health setting, while the majority of respondents practised in private offices. Regarding access to care, 53% indicated their practice did not accept Medicaid coverage, while 58% reported making a moderate to significant impact on access to care. However, 35% reported working in Penobscot County, which is not a dental provider shortage area. The most frequently provided services were restorative services (72%), topical fluoride (40%), sealants (37%), and child prophylaxis (26%). Over 80% of respondents reported less than half of their continuing education courses being relevant to EFDA practice. Over 20% felt specific, additional topics in preparatory education could increase access to care. **Conclusions:** EFDA providers in Maine are providing much needed services, however they may not be providing access to care for the intended at-risk and underserved populations in certain geographic areas. Further research is needed on this topic.

**Problem Statement:** Oral cancer has a high mortality rate which is often attributed to delays in diagnosis. Registered dental hygienists (RDHs) are instrumental in detection and referral of suspicious lesions. No national study of Canadian RDH oral cancer screening (OCS) practices has been completed. **Purpose:** This study investigates whether RDHs are routinely conducting OCS. Factors that may mediate OCS provision and ability to discuss sensitive topics with patients are also examined. **Methods:** A cross-sectional survey design was used. A web-based survey was developed, pretested, and validated prior to dissemination. The survey link was mailed out nationally through dental hygiene colleges and associations. Only practicing RDHs were prompted to complete the survey. Descriptive statistics were used to identify data trends. The McNemar test was used for categorical dependent data; nonparametric tests (Mann-Whitney U and Kruskal-Wallis) were used to analyse Likert questions; multiple regression was used for prediction of continuous outcomes; and Spearman’s correlation was used for detecting relationships. Bonferroni’s correction was applied to reported p values with multiple comparisons. Ethics approval was obtained from the University of Alberta Research Ethics Board (Pro00055150). **Results:** A total of 256 surveys were used for analysis, primarily from Ontario, Alberta, and Nova Scotia. Sixty-four percent of RDHs reported conducting OCSs during their regular process of care. Ninety-six percent of intraoral components are inspected in an OCS compared to 73% of extraoral components. Confidence in OCS technique was high (70%) but those with a bachelor’s degree reported feeling more prepared than those with a diploma (p = 0.002). The average time to conduct an OCS was 4 minutes, with the majority agreeing there is sufficient time to conduct the screening (57%). Only 37% felt their education prepared them to discuss sensitive topics. **Conclusions:** RDHs are conducting OCSs more than two-thirds of the time, however they lack comfort in discussing sensitive topics.

**Problem statement:** Treatment for head and neck (H&N) cancer can lead to experiences of intense symptom distress, particularly within the oral cavity and pharynx. Understanding these and their impact on physical, emotional, and psychosocial effects could support patientand family-centred care. **Purpose:** The purpose of this study was to develop an understanding of patient and partners’ oral/dental lived experiences in the context of H&N cancer. This understanding will provide critical insights for health care providers and decision makers to support patient and family-centred care. **Methods:** Hermeneutic phenomenology as described by Max van Manen guided this study. Purposive sampling was used to recruit 13 study participants. Each participant completed a semi-structured interview, which was digitally recorded and transcribed verbatim. A prolonged engagement with the data and interpretive memos led to the articulation of phenomenological meaning of the experiences within the final interpretation. This study received institutional REB and site access approval. **Results:** Treatment has a profound and sustained impact on the H&N cancer patient and his or her partner. During treatment, difficulties with eating, pain, xerostomia, and weight loss were reported. Long-term, persistent eating difficulties, xerostomia, dental disease and its related cost were distressing to participants. Despite effects that impeded adequate nutritional intake, participants resisted the placement of a percutaneous endoscopic gastrostomy tube. The process of resistance was complex and influenced by meanings associated with becoming and living as a cancer patient. The symbolic meaning of food and eating impacted the participants’ subjective concepts of self and illness. **Conclusion:** The intensity and extent of the patient experiences described suggest that there is a critical need to develop interventions that respond to living with symptoms of H&N cancer. This study has given voice to the participant experience, which should inform and guide the development of clinical practice and recommendations.

**Problem statement:** It is an ethical responsibility for dental hygienists to perform oral cancer screenings (OCS). Previous studies have revealed that dental hygienists perceive themselves as knowledgeable about OCS, but are not transferring this knowledge into practice. Time constraints have been identified by dental hygienists as the main barrier to performing OCS on all clients. **Purpose:** 1) To determine how long it takes senior dental hygiene students, recent graduates, and dental hygiene faculty to conduct an intra and extraoral examination; 2) to determine the time required to complete the salivary gland function (SGF) testing component of the intra/extra oral examination. **Methods:** Ethics approval was obtained from the Research Ethics Board at Dalhousie University. A convenience sample of 28 participants (13 students, 9 alumni, 6 faculty) completed an intra and extraoral examination according to criteria taught at the School of Dental Hygiene, Dalhousie University while being timed. The total time to complete the exam and the time required for the SGF were recorded by calibrated researchers. Descriptive statistics were used to summarize the data via SPSS Statistics version 23. **Results:** The overall mean time (±SD) to perform the full examination was 5 min 26 s ± 1 min 4s (students: 5 min 23 s ± 51 s; alumni: 4 min 40 s ± 28 s; faculty: 6 min 42 s ± 1 min 2 s). The mean time (±SD) to perform the SGF test was 49 s ±12 s (this time was similar for all groups). **Conclusion:** Time has been reported by dental hygienists to be the main barrier to performing oral cancer screenings, however we have shown that a comprehensive intra and extraoral exam takes approximately 5.5 minutes. Performing SGF as part of the exam (considered non-essential for oral cancer screening) accounts for approximately 18% of this time. This translates to less than one minute which may not be clinically significant in practice. Further research is needed on means of reducing barriers (real or perceived) to routine practice of oral cancer screenings.

**Problem statement:** Potential harm from ionizing radiation has led to the development of guidelines, which may or may not be followed by clinicians, for the protection of patients and practitioners from unnecessary radiation exposure. **Purpose:** This study surveyed US dental hygienists regarding radiology prescribing practices. **Methods:** The survey, consisting of 62 knowledge and practice items pertaining to dental x-rays, was based on the 2012 American Dental Association (ADA) and Food and Drug Administration (FDA) guidelines, Dental Radiographic Examinations: Recommendations for Patient Selection and Limiting Radiation Exposure. The study was granted exempt status by TAMBCD’s IRB. The survey link was emailed to 10,000 subscribers of Dimensions of Dental Hygiene magazine and posted for its 40,000 Facebook followers. **Results:** Of the 517 survey respondents, 505 confirmed their identity as dental hygienists. Data analysis included descriptive statistics, cross tabulations, and chisquare analyses. Approximately 46% reported the dentist determined the need for radiographic films or images, and 42% reported the decision was made by the dental hygienist. Eighty-two percent stated a clinical examination was not performed prior to obtaining radiographs, and 70% reported radiographs were ordered based on a set time interval. Approximately 36% exposed radiographs based on insurance reimbursement. For adult recall patients with no clinical caries and low caries risk, general and corporate dental practices obtained bitewing radiographs more frequently (every 12 months) than educational institutions (p < 0.05). For children and adolescent recall patients without caries and low caries risk, corporate dental practices obtained bitewing radiographs more frequently on children (every 6 months) than educational institutions (p < 0.05); for adolescent patients, corporate and general dental practices preferred to acquire bitewing radiographs every 12 months, whereas educational institutions preferred every 18 months (p < 0.05). **Conclusions:** These findings suggest the respondents’ practices did not fully adhere to the 2012 ADA/FDA guidelines for prescribing dental radiographs.

**Problem statement:** According to recent NHANES statistics, the prevalence of caries in at-risk individuals increased between 1994 and 2012, despite exposure to various fluoride products. Likewise, natural dental products are more and more prevalent even though they contain no therapeutic agent and in time would contribute to a rise in carious lesions. **Purpose:** Proposed trial aims to test a natural toothpaste solely containing 25% concentrated xylitol as the anticarious therapeutic agent as well as an anticariogenic antibacterial agent. **Methods:** A voluntary sample of 201 dyads (mother–6-month-old infant) were recruited from Pristina and randomly allocated to either test or control groups. The trial group consisted of twice a day toothbrushing with xylitol toothpaste for 24 months. The control group was exposed to normal preventive toothpaste with or without fluoride. Samples were collected at baseline and endpoint. A longitudinal prospective design was applied. Primary dependent variable was dmfs generated from ICDAS system. Primary independent variable was SM categories of infection from 0 to >105 SM/mL of saliva. Analysis used SAS software. The Ethical Committee of Pristina University approved this study. **Results:** Final group composition was 99 for the control group and 102 for the trial group. Twice daily 25% xylitol toothpaste exposure for 24 months led to a mean dmfs of 2.7 units for tested participants compared to 6.7 units for the control group by 60% (p = 0.001). This toothpaste also significantly reduced SM infection among test group participants between the ages of 6 and 30 months (p = 0.001). **Conclusion:** In the current study, natural strict 25% xylitol toothpaste used daily reduced the caries process, carious lesions, caries risk, and cariogenic bacteria. This study was funded by RSQB of Quebec.

**Objective:** To explore how overall caries was summarized for patients examined using the International Caries Detection and Assessment System (ICDAS). **Search strategy/Selection criteria:** A systematic database search up to July 2016 was carried out using PubMed, Ovid MEDLINE, Cochrane library, and ISI Web of Science electronic databases. Only studies that used the ICDAS for dental caries examinations were included. Studies were excluded if the examination was done for the validation/calibration of the ICDAS or if the examination was not done for the whole dentition. Measures used to report patients’ overall caries were considered. Search terms for both caries and ICDAS were used. **Data collection and analysis:** Data extraction was done by 2 reviewers separately. Indices and measures used to summarize patients’ caries level were evaluated in the selected studies. The index or measure of caries used and how it was calculated were extracted. Studies were grouped and summarized according to the index or measure used. **Results:** A total of 70 papers were selected. Of the selected articles, 56 were cross-sectional studies, 8 were randomized clinical trials, and 6 were cohort studies. A total of 40 different measures of caries were used. Individual ICDAS scores were the most commonly used measures as it was used in 17 studies. A total of 6 different dmft/DMFT and 7 different dmfs/DMFS combinations at different caries cut-off points were used. Two studies used mean ICDAS and one study used mean ICDAS in carious teeth. The Maximum ICDAS score and total ICDAS were used once. **Conclusions:** Most studies presented caries using categorical characteristics of the ICDAS. There are variations in the utilization of the system in summarizing caries between the studies. These inconsistencies do not allow comparison between different studies. Therefore, a consistent summary measure that reflects patient caries level is needed.

**Problem statement:** Various antimicrobial oral hygiene products are available to help protect patients against plaque-induced gingivitis, a common oral health disease characterized by gingival bleeding and inflammation. Clinical data comparing treatments would be useful to help assist dental hygienists with home hygiene recommendations. **Purpose:** To compare the efficacy of 2 antigingivitis dentifrices—a stabilized stannous fluoride (SnF2) and a positive control with triclosan— over a 2-month period. **Methods:** This was a randomized, positive-controlled, double-blind, parallel-group, IRBapproved clinical trial involving generally healthy adults with mild-to-moderate gingivitis. Two hundred qualifying subjects were randomized 1:1 to the 0.454% stabilized SnF2 dentifrice (Crest® PRO-HEALTH™ Clean Mint) or positive control dentifrice with 0.3% triclosan/0.243% sodium fluoride (Colgate® Total®). Dentifrice was distributed with a soft manual flat-trim toothbrush. Subjects were instructed to brush with their respective dentifrice according to each manufacturer’s instructions. The following efficacy and safety evaluations were conducted at baseline and month 2: Gingival Bleeding Index, Modified Gingival Index, and Oral Soft Tissue. Treatment groups were compared using analysis of covariance with baseline value as covariate. All statistical tests were 2-sided with a 5% level of significance. **Results:** One hundred ninety-seven subjects were evaluable; 98 in the triclosan group and 99 in the SnF2 group. Both groups showed a significant reduction in bleeding sites from baseline (p < 0.0001). The mean number of bleeding sites in the SnF2 group was reduced from 20.7 at baseline to 11.2 at month 2, compared to baseline and month 2 means of 21.95 and 14.3, respectively, for the triclosan group. The difference between groups at month 2 represented 21.8% fewer bleeding sites for the SnF2 group compared to the triclosan group (p < 0.0001). **Conclusions:** In this clinical study, the stabilized SnF2 dentifrice provided greater gingival bleeding reductions than the triclosan dentifrice.

**Problem statement:** Dental erosion is a common condition characterized by loss of enamel from external acids, such as acidic foods and beverages. Stabilized stannous fluoride (SnF2) dentifrice has been shown to offer protective benefits against erosion. **Purpose:** To compare the enamel protection efficacy of a stabilized SnF2 dentifrice and a marketed control dentifrice in a 10-day in situ erosion model. **Methods:** This was a single centre, double-blind, randomized, 2-treatment, and 3-period crossover clinical study approved by an IRB. The study was conducted with 12 healthy adults. Each study period comprised 10 treatment days. Subjects were randomized to one of two treatments each period: 1) Experimental 0.454% stabilized SnF2 dentifrice (Crest® PRO-HEALTH™ Clean Mint) or 2) Sodium fluoride dentifrice with potassium nitrate marketed for erosion protection (Sensodyne® Pronamel®). Subjects wore an intraoral appliance retaining 8 polished human enamel samples. Subjects used the assigned dentifrice, brushing lingual surfaces and then swishing, twice a day. Erosive challenge with orange juice occurred a total of 4 times on each treatment day. Enamel samples were measured using noncontact profilometry at baseline and day 10 for surface changes. Statistical analyses utilized a general linear mixed model with period and treatment as fixed effects and subject as a random effect. **Results:** The SnF2 dentifrice provided 26.9% greater erosion protection relative to the control dentifrice at day 10 (p < 0.03). Enamel loss adjusted means at day 10 were 9.117µm for the SnF2 dentifrice and 12.471µm for the control. **Conclusion:** This stabilized SnF2 dentifrice provided greater erosion protection than a control dentifrice marketed explicitly for antierosion benefits.

**Problem statement:** Clinical trials have shown advantages of oscillating–rotating (O-R) electric rechargeable toothbrushes versus sonic toothbrushes in reducing plaque and gingivitis. Most studies have evaluated comparable brush models (e.g., premium handles). Comparing a premium model to a mid-range model would further dimensionalize the relative efficacy of these technologies. **Purpose:** To evaluate an O-R electric (mid-range model) toothbrush with an angled-bristled brush head to a marketed sonic (premium model) toothbrush in reducing plaque and gingivitis over 8 weeks. **Methods:** This was a randomized, examiner-blind, parallel-group, 8-week, IRB-approved clinical trial. Generally healthy adults with mild-to-moderate plaque and gingivitis were assessed for baseline whole mouth gingival margin and approximal plaque, gingivitis, and gingival bleeding using the Rustogi Modified Navy Plaque Index, Modified Gingival Index, and Gingival Bleeding Index. One hundred fifty subjects were randomized 1:1 to the O-R brush (Oral-B® Professional Care 1000 with Oral-B® CrossAction® brush head) or the sonic brush (Sonicare® DiamondClean with DiamondClean brush head). Subjects brushed twice daily, 2 minutes per brushing, with their assigned toothbrush and standard fluoride dentifrice for 8 weeks. Plaque and gingivitis were reassessed at week 8 using the same methods. **Results:** One hundred forty-eight subjects completed the trial (75 O-R, 73 sonic). Statistically significant reductions in plaque and gingivitis (p < 0.001) were demonstrated by both toothbrushes over 8 weeks. Differences between groups were statistically significant for all plaque and gingivitis measures (p < 0.001) favouring the O-R brush. At week 8, the O-R brush demonstrated 27.7% to 46.8% greater plaque removal and 34.6% to 36.4% greater gingivitis reductions than the sonic brush. There were no adverse events. **Conclusions:** The mid-range O-R toothbrush handle with the angled-bristled brush head was more effective at reducing plaque and gingivitis than a premium sonic model.

**Problem statement:** Gingival recession is multifactorial. It is has been purported that toothbrushes that are highly effective at plaque removal could have a higher risk of trauma, leading to gingival recession. Purpose: To compare the effects of brushing with an oscillatingrotating (O-R) electric rechargeable toothbrush or a standard manual toothbrush on pre-existing gingival recession over approximately 3 years. **Methods:** This was a controlled, parallel group, randomized clinical trial approved by the International Medical & Dental Ethics Commission Freiburg. Healthy subjects with pre-existing recession (>2 mm) were randomized into 1 of 2 groups: O-R toothbrush or ADA reference manual toothbrush. Subjects brushed their teeth twice daily, for 2 minutes per brushing, with their assigned toothbrush and standard fluoride toothpaste. The same examiner assessed subjects for clinical attachment loss and probing pocket depths at 6 sites per tooth at baseline and months 12, 18, and 35. Gingival recession was calculated at pre-existing sites as the difference between clinical attachment loss and probing pocket depths. Safety was assessed by hard and soft oral tissue examinations. **Results:** One hundred and nine subjects were enrolled and 75 completed the study (37 in O-R, 38 in manual). Mean gingival recession (SD) for sites with initial recession did not differ significantly between groups after approximately 3 years (p > 0.05). Means (SD) at baseline and 3 years were 2.35 mm (0.35) and 1.90 mm (0.58), respectively, for the O-R group and 2.26 mm (0.31) and 1.81 mm (0.66), respectively, for the manual group. The reduction in recession was significant (p < 0.001) for both groups. There were no adverse effects on hard or soft tissues in either group. **Conclusions:** Preexisting gingival recession was not adversely affected by brushing with an O-R or manual toothbrush over 3 years. In fact, both groups showed a reduction in recession.

**Problem statement:** There are cases of periodontitis nonresponsive to typical treatment strategies. These cases demonstrate a need for novel treatment options focused on molecular interventions. **Purpose:** The purpose of this study was to determine the expression of recently discovered pro- and anti-inflammatory mediators: TREM- 1, TREM-2, RAGE, HMGB-1, and their soluble forms: sTREM-1, sTREM-2, and sRAGE in gingival crevicular fluid (GCF) during gingivitis and periodontitis to discover an appropriate target for future molecular interventions. **Methods:** The research protocol was approved by the Creighton University IRB (#1015786-1). Fourteen participants (5 healthy, 4 gingivitis, 5 periodontitis) consented and were enrolled in this blinded, ex vivo study. GCF samples were collected via PerioPaper® during scheduled appointments. Expression levels of TREM-1, TREM-2, RAGE, HMGB-1 and their soluble mediators in GCF samples were measured using commercially available ELISA kits. **Results:** Analysis of ELISA assays revealed greater expression of TREM-1 in GCF from patients with gingivitis (26,672 pg/mL) and periodontitis (15,118.8 pg/ mL) compared to healthy subjects (5091.6 pg/mL). Protein expression of RAGE, sTREM-1, and sTREM-2 were higher in healthy samples (2323.9; 1,511; and 202,871.5 pg/mL respectively) compared to periodontitis (103.2; 1229.8; and 37,101 pg/mL) with no expression in gingivitis samples. TREM-2 was found to be expressed only in samples from patients with periodontitis (2790.9 pg/mL) and HMGB-1 only in patients with gingivitis (13,246 pg/mL); sRAGE was not detectable in any of the samples. However, only differences in the expression level of HMGB-1 reached the threshold for statistical significance. **Conclusions:** Results from this study highlight potential differences in the expression levels of specific biomarkers between gingivitis and periodontitis. More research is needed, however, with a larger sample size, to draw definitive conclusions or elucidate a target for future molecular interventions to arrest periodontal diseases.

**Problem statement:** There are no published clinical research data on the efficacy of sodium chlorite plus zinc gluconate, whether in the form of a mouthrinse or in any other composition, on halitosis. **Purpose:** This quantitative study aimed to assess the efficacy of sodium chlorite plus zinc gluconate (SC+ZG) mouthrinse in adults with halitosis. **Methods:** This randomized, double-blind, placebocontrolled study used the Yaegaki et al. standardized oral malodor clinical research protocol. The study was approved by the MCPHS University IRB and open to adults 18 years and older, who complained of or had been told they had halitosis. Seventeen of 22 recruited subjects followed pretesting preparation. On test day, baseline measurements of hydrogen sulfide (H2S), methylmercaptan (MM), and dimethyl sulfide (DMS) were obtained using an OralChroma® CHM-2 gas chromatograph. Subjects were randomized to SC+ZG or placebo rinses. Supervised subjects rinsed with 15 mL of SC+ZG or placebo for 60 seconds and subsequently gargled with a second dose of the assigned mouthrinse for 30 seconds. Subjects were not permitted to eat or drink for 3 hours after the rinsing and gargling regimen, at which time measurements were repeated. **Results:** Using analysis of variance (ANOVA) for continuous variables and Fisher’s Exact Test for categorical variables, there were no statistically significant differences in demographics between the groups. Differences in effect estimates between treatment arms were found in mean gas concentrations of H2S and MM from baseline to postrinse. Mean H2S gas concentration decreased by 16.4 ppb (95% CI -54.9, 22.1) in the treatment group, but only by 2.9 ppb (95% CI –11.7, 5.9) in the placebo group and by 28.4 ppb (95% CI –54.8, –1.9) and 11.2 ppb (95% CI –31.8, 9.3) for MM gas in the treatment and placebo arms, respectively. Results were not inferentially statistically significant for any of the VSCs, likely due to the study being underpowered. **Conclusions:** Study findings did not support evidence of efficacy of SC+ZG on halitosis.

**Problem statement:** To date, there have been insufficient studies published concerning the knowledge, attitudes, and practices of dental hygienists regarding polypharmacy and off-label drug recognition and use. **Purpose:** This study examined the knowledge, attitudes, and practices of dental hygienists in California regarding polypharmacy and drugs used for off-label purposes both in medicine and dentistry. **Methods:** In a cross-sectional design, knowledge, attitudes, and practices (KAP) related to off-label drugs and polypharmacy were assessed via an online survey tool. The sample included licensed dental hygienists registered with the Long Beach and Tri-County Dental Hygienists’ Associations in Southern California (N = 360). Participant characteristics were calculated using descriptive statistics. ANOVA was used to assess differences in knowledge, attitudes, and practices when compared to 3 key variables: highest academic/professional degree, experience, and license type. This study was approved by the Human Subjects Committee, Idaho State University’s IRB (IRB-FY2016-379). **Results:** One hundred seven surveys were returned for a 34% response rate. Over half of respondents (53%) held an associate degree for their license, most (72%) worked in a general dentistry setting, and 46% had practised 15 years or less. Results revealed very low knowledge levels with 25% of respondents answering zero knowledge items correctly. Furthermore, no significant differences in knowledge and practices related to off-label drugs or polypharmacy were found based on type of licensure, highest degree achieved or years of experience. However, participants holding a bachelor’s degree or higher were significantly more confident (p = 0.011) in discussing polypharmacy with patients and colleagues. **Conclusion:** Participants showed a generally low level of knowledge related to off-label drugs and polypharmacy regardless of their level of education, years of experience or type of dental hygiene licensure. These results indicate a profound need for increasing content in pharmacology in both entry-level programs and continuing education courses.

**Problem statement:** Dental hygienists fully embrace their role in providing oral hygiene instructions (OHI) and recommendations to improve the health of their patients, and yet acknowledge that most of their patients do not comply with their recommendations. The issue may not be one of compliance but one of understanding and memory of the specifics of the instructions. **Purpose:** The purpose of the study was to compare perceptions of patients and dental hygienists (DHs) on OHI provided during the patient’s appointment to understand the barriers to effective communication and adoption of oral hygiene recommendations. **Methods:** After obtaining consent, 8 focus groups were conducted. DHs were interviewed on their OHI protocol and their patients’ adherence to instructions. Patients were interviewed separately regarding OHI provided during their appointments and their memory of the OHI provided. Sitting in a separate room with a oneway mirror, DHs viewed a focus group of patients who were not their own patients. **Results:** Themes that emerged were: all DHs feel they are effective in providing OHI, however patients revealed they do not understand or remember most of what the DH says. Patients feel vulnerable if OHI is given while they are in a supine position or simultaneously with scaling procedures. Also, many patients indicated that OHI is not remembered from the time of their appointment to the next time they perform oral care at home without digital or printed reminders. **Conclusions:** DHs need to change the environment in which OHI are given and provide tools to facilitate the conversation with patients to overcome barriers of understanding and memory. OHI should be given separately from other procedures and with patients in an upright position to give them the ability to absorb information and clarify if needed. Printed materials or digital tools and videos may improve understanding and retention which can improve oral health. Funded by Colgate Oral Pharmaceuticals, Inc.

**Problem statement:** Combining quality of life measures with traditional oral health assessment measures has been promoted by the World Health Organization and the US Department of Health and Human Services (Healthy People 2020) as a holistic approach to health and health care, yet adoption has been slow in clinical practice. **Purpose:** To evaluate qualitative feedback from practitioners administering the Pediatric Oral Quality of Life (POQL) survey in 2 community health organizations. **Methods:** This study was approved by the University of Missouri– Kansas City IRB (#16-086). Modified versions of the POQL were administered to children and parents or guardians by practitioners in fall 2016. A 17-item survey investigating best practices for implementing the POQL into practice was completed. **Results:** Twelve of nineteen practitioners (63%) provided full responses. Six were dental hygienists, 3 were dental assistants, 2 were office administrators and 1 was a dentist. The majority reported being employed full time and had worked in their organization for 2 to 3 years. All child POQLs were completed chairside at various times during the appointment. Practitioners reported it took approximately 5 minutes to administer and that most children were receptive although not always sure why they were being asked how they felt about their teeth and mouth. Parents and guardians raised no objections to filling out the POQL. Several practitioners reported that the POQL provided greater insight about the child and his or her oral health. When asked about challenges, practitioners noted the need to explain or rephrase questions, fitting the POQL into the workflow, and amount of time to implement. **Conclusion:** These early results show that implementing an OHRQoL measure in practice requires little time while providing a more complete picture of the impact of a child’s oral condition. Funding source: NIDCR (UH2DE025510).

**Problem statement:** The incidence of obesity is rising despite international initiatives. The World Health Organization has challenged all health care providers to contribute to efforts targeting increased awareness of healthy weight dietary choices among their patients. **Purpose:** The aim of this study was to explore dental professionals’ perceptions of extending advice to patients on sugar consumption and oral health to include overweight/obesity information. **Methods:** This crosssectional, international questionnaire of clinical dental professionals collected data electronically between April and August 2016. The questionnaire was developed using existing validated questions covering these domains: willingness and confidence, knowledge of the association between obesity, sugar consumption and oral health, selfevaluated abilities on screening and giving advice regarding sugar consumption and obesity, and potential barriers to providing advice. IRB approval was obtained. **Results:** 245 dental professionals (20 to 65 years) consisting of 79.6% females and 20.4% males completed the survey. Results showed the majority of dental professionals (75.3%) would be willing to give advice on obesity/overweight if a relationship between obesity/overweight and oral health was found. Significant misconceptions about obesity as a disease and its relationships to oral health were evident. Differences based on age, gender, and profession were not found. Although 88.3% of dental professionals are already providing counselling for oral and general health matters, less than 30% would start a conversation with their patients addressing sugar consumption and obesity. Lack of training and understanding of obesity as a disease was highlighted as a potential barrier to providing advice. **Conclusions:** Although dental professionals showed willingness to expand sugar consumption counselling beyond oral health messages, confidence is lacking. Further training is indicated to understand the association between sugar consumption, overweight/obesity, and their association with oral or general health.

**Problem statement:** The obesity epidemic in the US is of grave health and economic concern. Evidence suggests that consistent messaging should be provided by all health professionals to help patients improve their dietary and exercise habits. As preventive specialists, dental hygienists (DH) are well placed to take part in the interprofessional promotion of healthy nutrition and exercise habits for their patients. **Purpose:** The aim of this study was to examine the attitudes and confidence of US dental hygienists in providing nutrition and exercise counselling, and to determine what factors are associated with confidence in providing such counselling. A secondary aim was to compare these national results with those from a previously published study conducted in North Carolina. **Methods:** A cross-sectional design was used. A 54-question survey, previously used in the NC study and obtained with permission, was emailed by the American Dental Hygienists’ Association to its 13,846 members. Data were collected via SurveyMonkey software. Descriptive statistics were calculated for attitudes and barriers, and compared to the NC results. A regression model was used to determine factors associated with confidence. IRB approval was obtained from Columbia University. **Results:** The response rate was 11% (n = 1575). Ninety-two percent of respondents felt that DH have a role in patients’ overall nutrition; only 40% expressed interest in helping patients with obesity establish a plan for weight loss goals. Age (p < 0.0001), self-reported obesity (p < 0.0271), and place of work (p < 0.0012) were statistically significant predictor variables of confidence in providing counselling. Primary barriers included fear of offending the patient (94%) and lack of time (93%). Findings between the US and NC studies were generally comparable. **Conclusions:** While most US dental hygienists are interested in helping patients with their overall health, they report low to moderate confidence in providing nutrition and exercise counselling for weight management.

**Problem statement:** Faculty-mentored research with undergraduates has been identified as a need in US higher education. This study present steps involved in facultymentored research and the results from one research project. Ultrasonic instrumentation is an important aspect of periodontal therapy and has distinct advantages in comparison to hand instrumentation. However, little is known about the ultrasonic tip selection practices of dental hygienists. **Purpose:** The purpose of this study was to examine the strategies and variety of ultrasonic tip selection used by dental hygienists in treating patients. **Method:** Using a survey research design, dental hygienists responded to an online questionnaire designed by the researchers that was pilot tested to improve content validity. All responses were confidential and IRB approval was obtained from Weber State University. The data were analysed using descriptive statistics. **Results:** Dental hygienists were contacted via email with a response rate of approximately 20% (n = 44). Names and email addresses were obtained from the professional association. Most respondents (47.7%) indicated they used an ultrasonic 1 to 3 times a day to treat patients with mild, moderate or severe periodontal disease. While a large majority (88.6%) of the respondents felt it was clinically beneficial to use more than one tip during the treatment of a periodontal patient, most dental hygienists (42%) use 2 types of ultrasonic tips for periodontal instrumentation, and several respondents (37%) use just 1 tip. Respondents also identified the type of tip used the majority of the time. **Conclusion:** While dental hygienists noted the importance of using multiple tips for ultrasonic therapy with periodontal patients, a large percentage appear to limit the number of tips they use.

**Problem statement:** Faculty-mentored research to improve authentic learning for undergraduate students has been identified as a need in US higher education. This presentation highlights procedures for faculty-mentored research and presents findings from one research project. Ultrasonic instrumentation has been identified as a salient therapeutic treatment for periodontal disease. However, little is known about the actual practices of dental hygienists when using ultrasonic therapy for periodontal patients. **Purpose:** The purpose of this study was to ascertain the length of time ultrasonic therapy is used for periodontal patients and obtain information about the strategies dental hygienists use in monitoring ultrasonic tip wear. **Method:** Using a survey research design, dental hygienists responded to an online questionnaire designed by the researchers that was pilot tested to improve content validity. All responses were confidential, and IRB approval was obtained from Weber State University. The data were analysed using descriptive statistics. **Results:** Dental hygienists’ names and email addresses were provided by the professional association; individuals were contacted via email with a response rate of approximately 20% (n = 44). The most frequent length of time (full mouth debridement) spent with ultrasonic instrumentation for a patient with mild bone loss was 16 to 30 minutes (51% of respondents); for patients with moderate or severe bone loss it was 31 to 45 minutes (54% and 52%, respectively). Time spent on ultrasonic instrumentation for a periodontal maintenance patient was split almost equally between 1 to 15 minutes (50% of respondents) and 16 to 30 minutes (47.7% of respondents). Dental hygienists either monitor tip wear when the tip breaks (32%) or monthly (34%), and they monitor tip wear using a wear indicator card (over 70%). **Conclusion:** While the literature has suggested that more than 20 minutes of instrumentation per quadrant is needed for adequate removal of light to moderate subgingival calculus, dental hygienists appear to spend less than this length of time when treating periodontal patients.

**Problem statement:** The main goal of periodontal therapy is to disrupt the calculus harbouring biofilm that triggers the inflammatory response. The explorer is mainly used to detect calculus and the ultrasonic instrument is mainly used to remove calculus. The efficiency in dental hygiene care may improve if the ultrasonic instrument could be used in the detection and removal of calculus. **Purpose:** The purpose of this study was to compare the rater reliability of calculus detection among registered dental hygienists when using the ODU 11/12 explorer and Thinsert® ultrasonic instrument. **Methods:** Upon IRB approval, this study utilized a repeated measures design that involved 3 dental hygiene faculty from The Ohio State University Dental Hygiene Program and 30 patient participants from the Ohio State University community. Using the ODU 11/12 explorer and Thinsert® ultrasonic instrument, calculus was evaluated on 6 standardized teeth and on 4 possible surfaces per tooth. Data were analysed to evaluate for intrarater reliability, interrater reliability, sensitivity, specificity, PPV, and NPV. **Results:** Intrarater reliability was calculated by comparing calculus evaluations using the explorer and Thinsert® by each rater. Mean Kappa averages were found in the full agreement range (Kappa = 0.726, n = 2160, p < 0.01). Interrater reliability was calculated by comparing all raters’ calculus evaluations using the explorer and Thinsert®. The average measure of intraclass coefficient (ICC) value was 0.782 with a 95% confidence interval (CI) of 0.749 to 0.810 (F[1439, 2878] = 4.852, p < 0.01). When using the Thinsert® to evaluate for the presence or absence of calculus, there was a sensitivity of 75%, specificity of 97%, PPV of 81%, and NPV of 94%. **Conclusions:** Efforts can be focused on developing tactile sensitivity when using the Thinsert® ultrasonic instrument in the assessment, treatment, and maintenance of periodontal disease.

**Problem statement:** Dental hygienists have a high prevalence of work-related musculoskeletal disorders (WMSDs) due to repetitive motions and sustained postures, which often begin as a student when learning instrumentation skills. The majority of studies use selfreported methods to measure signs and symptoms, and research has primarily focused on instrument design. Currently, there is no standardized method for evaluating risk factors for developing repetitive hand injuries. **Purpose:** Develop and pilot-test an observational method, video recordings, for evaluating performance and body positions of dental hygiene (DH) students during instrumentation to determine their risk for developing WMSDs. **Methods:** With IRB approval and informed consent from participants and their patients, videos of 5 student DHs were obtained while providing patient care. Two stationary cameras captured a wide-angle view of body positions and a closeup view of the hand and wrist during scaling. Videos were coded by activity, time spent in each clock position (CP), and area of the mouth (AOM). Sustained postures (i.e., >45 seconds in one CP/AOM) were evaluated using RULA (rapid upper limb assessment), a validated instrument to assess the exposure to ergonomic risk factors including arms and wrists, neck, trunk, and legs. Scoring ranged from 1 to 7. **Results:** Average appointment time was 178 minutes (2.9 hours). Instrumentation comprised 57% of the appointment time, 82% of which was spent performing hand scaling. Students worked most frequently in the 9-CP (40% of the time), with equal time in each AOM. Sustained postures were noted in 71 video segments. Overall RULA scores were distributed around modes of 4 and 6, and the most frequent poor postures were wrist and neck flexion. **Conclusions:** RULA scores indicate moderate risk for these DH students. Video recordings were found to be feasible; however, adding a third view may improve analysis of sustained postures. Additionally, assessing hand strain during scaling will assist in evaluating risk for WMSDs. Funding for this project was provided by CDC/NIOSH Grant R01-OH010665.

**Purpose:** The aim of this cohort study was to evaluate the influence of glycemic control on the gingival bleeding of type 2 diabetic clients after brushing 3 times daily with a triclosan toothpaste for 4 weeks following oral hygiene instructions (OHI). **Methods:** Thirty-seven subjects were distributed into 2 groups according to their glycated hemoglobin (HbA1c) levels. The moderately controlled group (MOD) had 18 individuals with HbA1c <9%; the poorly controlled group (PLY) had 19 individuals with HbA1c =9%. After clinical examination, all study participants received OHI which included brushing 3 times daily with a toothpaste containing triclosan using the Bass technique and the daily use of dental floss. Between group differences were analysed using unpaired t tests, while within group differences were calculated with paired t tests. **Results:** Gingival bleeding index (GBI) was assessed at baseline (MOD = 65.1±15.1%; PLY = 67.6±20.2%) and after 4 weeks. At the end of the study period, a significant reduction in GBI was noted in the MOD group (40.2±18.5%; p < 0.001) but not in the PLY group (56.5±21.2%). When comparing the 2 study groups, a statistically significant difference (p = 0.017) between groups was found. A significant association was also observed for a 25% GBI reduction in the MOD group in comparison with the PLY group (p = 0.026) as determined with the Fisher’s exact test. **Conclusions:** Type 2 diabetic clients with moderate glycemic control showed improvements in gingival bleeding after oral hygiene instructions and use of a dentifrice containing triclosan. However, no significant improvements were found in the poorly controlled diabetic clients. This regimen seemed insufficient to improve the bleeding status of the poorly controlled group. Incorporating more specific motivational strategies may be needed.

It has been suggested that Generation Y students, both adults and youth, have different learning styles than students of the past, and may require different teaching strategies to engage them. Educators may need to adapt their classroom approach in order to successfully involve and teach this newer generation of students. **Objective:** The purpose of this review is to determine what education strategies will best engage Generation Y students and to highlight how these strategies can be assimilated into dental hygiene education programs. **Methods:** Literature searches of the following databases were conducted: Athabasca Library, Cochrane Library, ProQuest Nursing, Google Scholar, PubMed, and EBSCOhost. Key words included Generation Y, Millennial student, action oriented learning, collaborative classroom, and dental hygiene educators. Articles were selected based on purpose of study and relevance, year published, authors’ credentials, and study design. **Results:** Thirty eight articles were included in this review. The literature confirmed the differing characteristics and learning styles of Generation Y students. Literature analysis resulted in suggestions for best engaging this learner group and developing specific successfully integrated teaching strategies for dental hygiene programs. **Conclusion:** Generation Y students benefit from action-oriented learning strategies that engage them more fully in the classroom. More research is needed to determine which strategies work best and why some educators have not changed their teaching style to best engage these students.

Re: Lavigne S. The baby boomer takeover: Canada’s changing demographics and its oral health care implications. Can J Dent Hyg. 2017;51(2):63–65.

**Objective:** Charcoal toothbrushes have been marketed widely with manufacturers’ claims of lesser bacterial contamination owing to the presence of activated charcoal. The aim of this study was to evaluate the bacterial contamination of charcoal bristles compared to non-charcoal bristles in used toothbrushes. **Material and methods:** Ninety participants were involved in the study. They were given standard brushing instructions on the use of a charcoal toothbrush, and were asked to return the used brushes after 1 week of usage. After a 1-week washout period, the participants were then provided with similar brushing instructions and a non-charcoal toothbrush, and were instructed to return the brush after another week of usage. Bristles of the used toothbrushes were sectioned and placed in a nutrient broth. A pipette was used to extract 0.1 mL of nutrient broth to smear on agar plates. A colony counter was used to measure colony forming units (CFU) after 24 hours of incubation. Data collected were analysed using a paired sample t-test. **Results:** The mean CFU count for non-charcoal bristles was almost double (106.3; 95% CI 53.39, 159.28) that of charcoal bristles (58.8; 95% CI 15.09, 102.55). However, there was no statistically significant difference between the two groups (p = 0.198). **Conclusion:** This study shows no statistically significant difference in bacterial counts between bristle types, despite substantially lower CFUs in the charcoal bristles compared with non-charcoal bristles after 1 week of use.

**Background:** The purpose of this descriptive study was to evaluate perceptions of local anesthesia learners and to identify practices that would aid in increasing and improving clinical confidence and performance. **Methods:** A convenience sample of 23 dental hygiene students in a baccalaureate degree program was given a pretest survey upon completion of the didactic component of their local anesthesia course. Participants were randomly assigned into test and control groups and given a practice device. After a practice session, a posttest survey was administered and a descriptive statistical analysis was performed. **Results:** The pretest survey revealed that 91% of participants felt prepared to begin the clinical portion of their local anesthesia course, and 96% felt the student-to-student model was critical in learning how to administer local anesthesia injections. Posttest results remained unchanged in both test and control groups (p < 1.0). Pretest results also showed that 74% of participants preferred that their first local anesthesia injection be on a model/typodont. Posttest results demonstrated a statistically significant shift in this preference (p < 0.02), with 67% in the test group and 63% in the control group preferring a human subject for their first injection. **Discussion:** In this study, the practice itself was the cause of changing perceptions rather than the device; thus the experience alone shaped the students’ perceptions. **Conclusion:** Adjuncts to local anesthesia education contribute to learning, but are unlikely to replace the student-tostudent model. Those seeking to increase their scope to include local anesthesia administration should expect to learn via this traditional method.

The lesbian, gay, bisexual, transgender (LGBT) community represents a population of people diverse in gender, sex, and sexual orientation. This literature review explores the current research on the health care experiences of LGBT individuals in North America in an attempt to identify the barriers to care that they face and develop strategies to increase their overall health. The health care experiences of LGBT individuals were explored across 7 dimensions: existence, bodily integrity, emotional integrity, worth, uniqueness, expression, and power. The LGBT community has unique health concerns and is at higher risk for mental health conditions, substance use, and suicide. These health disparities have been associated with social discrimination, ignorance, and assumptions made about gender, sex, and sexuality. Such barriers encountered by this population have also led to delayed or discontinued care, non-disclosure of sexuality or gender identity, increased negative health behaviours, and internalized stigma. The experiences that were identified reveal a strong need to reassess and strengthen the cultural sensitivity training and LGBT education provided to health care professionals.

The earth’s resources, as we know them, are depleting and extremely limited. The amount of medical waste accumulated from a single operator within a dental office and collectively as a profession places dentistry and dental hygiene in a culpable position for the detrimental impacts on our natural environment. Being “envirodentally friendly” involves conscientious and sustainable strategies that encourage dental professionals to reduce consumption of energy and production of waste. This short communication reviews the literature on this topic. Raising environmental consciousness for dental professionals in North America and suggestions for “green” approaches are explored. Four main areas of research discussed in this article are the 4 Rs of waste reduction; going digital in the dental office; wet versus dry vacuum systems; and infection control methods.

**Objectives:** Contemporary ultrasonic instrumentation technology has improved its clinical utility due to enhanced subgingival access, disruption of biofilm, and debridement of light deposits. However, it is unknown if dental hygiene curricula in Canada have kept pace with this progression. This study explores dental hygiene ultrasonic instrumentation curricula from program directors’ perspectives. **Method:** All 40 Canadian dental hygiene program directors were invited to participate in a survey of their ultrasonic instrumentation curricula through an electronic questionnaire. The survey instrument was designed specifically for the study and included closed- and open-ended questions on ultrasonic instrumentation curricular elements. Statistical and thematic analyses were conducted. The study received ethics approval from the University of Manitoba. **Results:** Of the invited Canadian dental hygiene program directors, 19 (47.5%) completed the survey and reported a range of available ultrasonic equipment, both purchased and borrowed. The use of magnetostrictive technology was most common. The instructional hours devoted to ultrasonic instrumentation theory and preclinical and clinical training ranged from 2 to 20 hours, 0 to 12 hours, and more than 20 hours, respectively. Timing of the introduction to ultrasonic instrumentation education in the curriculum varied widely. Additionally, a considerable reliance on guest speakers (90%) and textbooks (95%) was observed. Student evaluation was mostly based on observation, with and without examination (21%, 36%) primarily without the aid of assessment rubrics (21%). While criteria for ultrasonic use were client based, some aspects of the criteria were not grounded in current theory. Program or course objectives related predominantly to theoretical knowledge as opposed to clinical skills. **Conclusions:** While appropriate ultrasonic technology is available to dental hygiene students, there are some deficiencies in Canadian dental hygiene ultrasonic curricula, such as a lack of evidence-based, contemporary approaches to ultrasonic instrumentation instruction. The authors recommend careful reviews, modifications, and future evaluations of ultrasonic curricula within all aspects of Canadian dental hygiene programming.

**Background:** The objectives of this study were two-fold: 1) to investigate the prevalence of client re-exposure from images taken by dental hygiene students; and 2) to examine the causes of these errors. This information is essential for tailoring educational interventions to prevent specific errors from occurring, reduce repeat client exposure, and ensure an effective radiation dose. **Methods:** Two digital techniques for taking intraoral radiographs—bitewing and periapical—were investigated. Data were consecutively collected during the 8-month dental hygiene undergraduate academic year. Calibrated radiology instructors evaluated all primary images following a standardized template. Original images were taken using both direct and indirect technologies. The prevalence of and reasons for client re-exposure (retakes) were determined. **Results:** A total of 1886 reviewed images, consisting of 1296 bitewings and 590 periapicals revealed an overall retake prevalence of 6.5%. Periapical and bitewing radiographs, evaluated by projection, had similar retake rates: 5.6% and 6.9%, respectively. Image receptor misplacement was the cause of 52% of the retakes—42% from bitewing radiographs and 9.8% from periapical radiographs. Inadequate coverage of the apical areas caused 10.5% of direct sensor and 2.5% of photostimulable phosphor plate (PSP) retakes in periapical radiographs. **Conclusion:** The most common cause of retakes for periapical radiographs was the “cutting off” of apical areas. Image receptor misplacement was the most common cause of bitewing retakes and the most common cause of retakes overall. These issues should be addressed in schools and clinical practice to reduce re-exposure rates and thus client dose.

**Objective:** This scoping review examines literature on the effectiveness of early pediatric dental homes based on clinical, behavioural, and cost parameters. **Methods:** A search of MEDLINE-Ovid, PubMed, CINAHL, Embase, Cochrane Database of Systematic Reviews (CDSR), Scopus, and BioMed Central databases was undertaken using “dental home” and “dental homes” as key words. In total, 232 non-duplicate citations were identified. After reviewing the titles and abstracts of these citations, 14 full articles were reviewed. In the final data set, 7 articles met the inclusion criteria of preschool study population and a focus on effectiveness parameters. **Results:** The existing body of evidence generally supports the effectiveness of early pediatric dental homes for improving clinical outcomes (i.e., dmft scores) and behavioral outcomes (i.e., including utilization of future dental care services), and offering potential cost savings. However, exact quantifications of the impact on clinical and behavioral outcomes as well as cost savings vary due to heterogeneity of study design and methodological considerations related to level of evidence. **Conclusion:** Current research generally substantiates the establishment of a dental home model as an effective practice to improve early pediatric oral health.

**Background:** To control biofilm and prevent gingival inflammation and disease, mechanical methods of oral hygiene can be complemented with a therapeutic oral rinse. Much research has been conducted on commercially available oral rinse products, and there is also considerable research being conducted on formulations not yet available to the Canadian market, of which many are natural or herbal products. This comprehensive review focuses on non-commercially available therapeutic oral rinse products and is the second part of a 2-part position paper and statement that replaces the 2006 Canadian Dental Hygienists Association position paper on oral rinsing. **Methods:** Based on a PICO question, a literature search using MEDLINE-PubMed, Cochrane Central Register of Controlled Trials, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases was conducted in stages. The search was limited to English-language articles published between 2006 and 2016. Articles were selected if they focused on predetermined variables, and each article was reviewed utilizing an analysis table to identify the study parameters. **Results:** The search returned 452 studies, and initial screening of titles and abstracts identified 20 papers for full review. An additional 25 articles identified through hand searching resulted in 45 full-text articles retrieved. Of these, 26 studies were included in the final review. Studies were categorized and reviewed according to a research-stage taxonomy. Discussion and **Conclusions:** Because no long-term (=6 months) clinical trials have been conducted on any non-commercial oral rinse formulations, statements about these rinse products’ effectiveness or safety cannot be made at this time. Several products did show efficacy in lower level research, indicating that further study of these specific formulations may be warranted. There is a need for more well-conducted studies using standardized research designs to produce findings that dental hygienists and other oral health professionals can use to guide their client recommendations for appropriate oral biofilm control

The need for interprofessional education (IPE) has been well documented and communicated by many prominent governmental bodies and health organizations. A growing body of research demonstrates the benefits of IPE. This short communication defines IPE and collaborative practice, discusses related research, assesses the dental hygiene practice landscape pertaining to collaborative practice, introduces a national interprofessional competency framework, and offers insight into future research needs. The article also highlights how IPE is operationalized in the University of British Columbia’s Dental Hygiene Degree Program and identifies available resources for IPE facilitation. The purpose of this article is to inform educators and practitioners of the importance of IPE and the impact it may have on collaborative practice.

**Purpose:** The purpose of this study was to determine if visible tattoos affected dental clients’ perceptions of dental hygienists. **Methods:** A survey was administered online to 203 subjects via a commercial web source. Participants viewed 1 of 3 photographs of a dental hygiene model wearing short-sleeved scrubs without a tattoo, with a small tattoo on the wrist or with a large sleeve tattoo on the arm. Respondents rated the professionalism of the dental hygiene model based on appearance and also indicated their willingness to use the dental hygienist’s practice regularly. Finally, participants indicated whether or not they had tattoos. **Results:** The large tattoo negatively influenced perceptions of the dental hygienist’s professionalism compared to no tattoo or a small tattoo. However, the dental hygienist with the small tattoo was not rated lower on professionalism. Furthermore, respondents with and without tattoos had a lower willingness to use the dental practice when the dental hygienist had a large tattoo. Although respondents with tattoos did not feel the dental hygienist with the small tattoo appeared to be more professional, they did have a greater intention to use the dental practice itself compared to respondents without tattoos. **Conclusions:** Large visible tattoos are perceived negatively by dental clients, with and without tattoos. Therefore, having a large visible tattoo may hinder clients’ positive perceptions of the dental hygienist and puts the dental hygienist at risk of being negatively perceived by clients in the dental practice setting. While dental clients have a lower intention to use dental practices that employ dental hygienists with large tattoos, they are far more tolerant of small visible tattoos, particularly if they have tattoos themselves. Hence, it may be unnecessary for dental practices to adopt a “no visible tattoo” policy and instead to consider tattoos on a case-by-case basis.

**Objective:** The aim of this study was to assess the efficacy of sodium chlorite plus zinc gluconate (SC+ZG) mouthrinse in adults with halitosis from volatile sulfur compound (VSC) sources, using a randomized, double-blind, placebo-controlled clinical model. Investigators used the Yaegaki et al. standardized oral malodour clinical research protocol.1 **Methods:** Seventeen (n = 17) subjects followed pre-testing preparation. On test day, baseline measurements of hydrogen sulfide (H2S), methylmercaptan (MM), and dimethyl sulfide (DMS), were obtained using an OralChroma® CHM-2 gas chromatograph. Subjects were randomized to SC+ZG or placebo rinses. Supervised subjects rinsed with 15 mL of SC+ZG or placebo for 60 seconds and subsequently gargled with a second dose of the assigned mouthrinse for 30 seconds. Subjects were not permitted to eat or drink for 3 hours after the rinsing and gargling regimen, at which time measurements were repeated. **Results:** The study revealed some sizable differences in effect estimates between treatment arms when comparing changes in mean gas concentrations baseline to post-rinse. However, the results were not inferentially statistically significant, likely due to the study being underpowered. **Conclusion:** The study did not provide statistical evidence of efficacy of SC+ZG on all VSC halitosis, but demonstrated a slight trend in reducing H2S and MM gas concentrations. Larger trials to establish efficacy and investigate a possible cumulative effect of SC+ZG mouthrinse are required. This is the first independent and disseminated study on SC+ZG mouthrinse.

**Background:** Mechanical methods of oral hygiene have been shown insufficient in controlling biofilm and preventing the initiation and progression of gingival inflammation and disease. These findings provide the impetus for additional research and the broader use of therapeutic oral rinses by adults. This position paper updates and replaces the 2006 Canadian Dental Hygienists Association position paper on oral rinsing to guide dental hygienists and other dental professionals in making client recommendations. **Methods:** A literature search using MEDLINE-PubMed, the Cochrane Central Register of Controlled Trials, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases was conducted in stages. The search was limited to English language articles published between 2006 and 2016. Articles were selected if they focused on predetermined variables. Each article was reviewed utilizing an analysis table to identify the study parameters. **Results:** The search returned 452 studies, and initial screening of titles and abstracts identified 42 papers for full review. An additional 24 articles identified through hand searching resulted in 66 full-text articles retrieved. Of these, 46 studies were included in the final review. Studies were categorized and reviewed according to a research-stage taxonomy. **Discussion and Conclusions:** The research demonstrates that a commercially available essential oil oral rinse, with a fixed combination of thymol 0.063%, eucalyptol 0.091%, and menthol 0.042%, provides statistically and clinically significant plaque and gingival inflammation reductions beyond that accomplished by mechanical means. While chlorhexidine gluconate rinse remains the gold standard with regard to plaque reduction, its negative side effect profile precludes long-term use. Several other products demonstrated superior efficacy to placebos and require further research. Among non-prescription oral rinses, the essential oil rinse was most effective, safe, and acceptable to study subjects, and should be recommended as a daily complement to tooth brushing and interdental mechanical cleansing for adult clients.

Periodontal diseases and conditions remain challenging to classify. The treatment options should follow a diagnosis that accurately represents the client’s periodontal status and history. The most widely used diagnostic classification stems from recommendations made in the 1999 International Workshop for a Classification of Periodontal Diseases and Conditions.1 Recently, the American Academy of Periodontology (AAP) has suggested interpretations to this periodontal disease classification in an attempt to address its limitations, such as the primary emphasis on clinical attachment levels as the main classification criterion, as well as the difficulty in distinguishing between aggressive and chronic periodontitis and in determining localized versus generalized periodontitis.2 The suggested AAP modifications will be presented during the next World Workshop in Clinical Periodontics to be held in November 2017. This article reviews the history of periodontal disease classification and presents recommendations for clinicians on how to classify different forms of periodontal diseases.

**Background:** The purpose of this study was to examine relationships between acculturation patterns and oral health behaviours and attitudes among Japanese immigrants in Greater Vancouver, British Columbia, Canada. **Methods:** This cross-sectional study used 3 questionnaires: a selfdesigned demographic/socioeconomic questionnaire, the East Asian Acculturation Measure (EAAM) to identify acculturation patterns of East Asian immigrants after migration to North America, and a modification of the Hiroshima University Dental Behavioural Inventory (HU-DBI) to evaluate oral health behaviours and attitudes. The convenience sample (N = 48) was recruited by networking. Data were analysed using descriptive statistics, Spearman (rs) and Pearson (r) correlations, independent samples t-test, and multiple linear regression analysis. **Results:** Mean HU-DBI scores were 3.16 of 12 total. Mean EAAM scores were as follows: assimilation, 2.86; separation, 3.71; integration, 4.41; and marginalization, 3.08 of 7.0 total. Pearson correlation analysis indicated an inverse association between age and assimilation (r = –0.392, p = 0.012). Income was significantly associated with oral health behaviours and attitudes (rs = 0.287). Marginalization (p = 0.022), detachment from both cultures, was the only significant predictor of HU-DBI scores; the higher the marginalization, the lower the HU-DBI. Separation, the reconfirmation of traditional culture, was suggestive of a prediction (p = 0.051). **Conclusion:** Improvement in oral health behaviours and attitudes in Japanese immigrants is needed. Because a relationship exists between acculturation and oral behaviours/attitudes, oral health education in dental hygiene practice and public health programs should target Japanese immigrants, with special consideration for less acculturated individuals and those in lower socioeconomic strata. Further study of relationships between acculturation and oral health behaviours is indicated.

**Introduction:** Monitoring trends in oral disease is essential to identifying population needs and informing policies to improve the oral health status of Canadians. At present, effort to examine income-related inequalities in untreated dental disease, such as dental decay, and their changes over time has been minimal in Canada. This article examines and compares income-related inequalities in decayed teeth in Canada between the 1970s and 2000s. **Methods:** A secondary data analysis using the Nutrition Canada National Survey 1970–1972 and the Canadian Health Measures Survey 2007–2009 was performed in order to examine individual- and population-level income-related inequalities in dental decay. Income quintiles and concentration indices for the presence of one or more decayed teeth were derived using indirect standardization and multivariate logistic regression. **Results:** Results highlight that income gradients in decayed teeth have persisted over time, with higher income groups experiencing greater reductions in the prevalence of decayed teeth than those of lower income. Higher concentration indices exhibited in more recent surveys suggest an increase in income-related inequality in decayed teeth over time. **Conclusion:** Our findings provide a foundation for measuring changes to income-related inequalities in oral disease in the Canadian population and reveal that inequalities in decayed teeth have persisted despite overall reductions in the presence of dental decay over time.

When compared to other dental professionals, dental hygienists who work in clinical practice may be at higher risk for musculoskeletal disorders (MSDs) due to procedures that involve precise, repetitive motions, as well as awkward and static postures. MSDs encompass a range of injuries that can affect both the hard and soft tissues of the body, typically resulting from repetitive strain and cumulative trauma. The reported oneyear prevalence rate of MSDs in dental hygienists ranges from 60% to 96%, with pain most frequently presenting in the neck, shoulder, wrist, hand, and back. To manage their pain, many dental hygienists seek conventional solutions, such as medication and splints, while others turn to complementary and alternative methods, such as massage therapy and yoga. MSDs can become a significant concern for dental hygienists working in clinical practice. Without in-depth knowledge of musculoskeletal health and injuries, as well as preventive and/or coping methods, dental hygienists may be forced to endure daily pain while continuing to work. If the injury is allowed to progress beyond a certain stage, some dental hygienists may have no option but to leave clinical practice. The objective of this literature review is to determine the impact of occupation-related MSDs on dental hygienists who work in clinical practice.

**Purpose:** The purpose of this study was to identify attitudes and experiences of dental hygiene faculty regarding interactions with current undergraduate dental hygiene students on Facebook (FB). **Methods:** In 2013, an online survey instrument was administered to 232 dental hygiene faculty members at 33 dental hygiene programs in Texas, Oklahoma, and New Mexico. A total of 94 dental hygiene faculty members participated, representing a 41% response rate. Descriptive and inferential statistics were used to analyse the data. **Results:** Of the respondents who indicated they had a FB account (84.2%), only a few (12.5%) were friends with students on FB. The majority of respondents (69.1%) felt it was inappropriate for faculty and students to interact on FB. Many felt the line between faculty and students was blurred because of FB interaction (68.1%). Over half (54.3%) agreed that faculty should use a separate FB page to interact with students. Just over 78% of faculty desired institutional guidelines for interactions on FB. **Conclusions:** Few dental hygiene faculty use FB either to interact with students or as a platform for academic use. This study supports the need for best practice guidelines to assist faculty in navigating the ambiguity of social networking relationships.

**Background:** Traditional health care values the technical skill and biomedical knowledge of health care professionals (HCPs), allowing for passiveclient and dominant-HCP relationships. These types of relationships may not always prioritize the wants and values of the client and thus may not facilitate high levels of compliance. In recent years, the emphasis has shifted away from passive compliance and has moved towards including clients actively as partners in their care. **Objective:** This narrative literature review explores how the quality of the client–dental hygienist relationship affects client compliance. It examines 19 full-text original research studies published between 2002 and 2014, whose methodologies include quantitative, qualitative or mixed method designs, and highlights key themes associated with improving or decreasing client compliance. **Discussion:** Themes associated with improved client compliance include effective communication, client-centred care, shared decision making, and trust. Themes associated with decreased client compliance include lack of trust, ineffective communication, feelings of disconnection, and paternalistic relationship styles. **Conclusion:** Non-adherence to treatment interferes with successful outcomes. Interventions aimed at improving the quality of the client–dental hygienist relationship may be the key to increasing client compliance. Dental hygiene programs should integrate these key themes into student learning opportunities, in order for developing dental hygienists to appreciate that effective clinical skills extend beyond the technical requirements of instrumentation. Future research should explore the success of such interventions in dental hygiene. In particular, qualitative studies could explore how this relationship evolves over time, considering the perspectives of both the client and dental hygienist.

As prospective members of a health care profession that is experiencing expanded scope of practice, dental hygiene students in Canada require supplemental training to prepare for new and advancing roles. In order to prepare dental hygiene students for potential limited prescriptive authority in Manitoba, a novel pharmacist-taught pharmacology course was developed and delivered. Course learning objectives were mapped and designed to incorporate the national entry-to-practice competencies and standards for dental hygienists. Using a single dental hygiene pharmacology text and licensed pharmacist academics as instructors, an innovative course was successfully implemented with positive outcomes and favourable perceptions of benefit among students.

Letters to the Editor

Letters to the editor

Letters to the editor - The author responds

**Background:** The outcomes of Canadian dental hygiene baccalaureate education have been explored by the Canadian Dental Hygienists Association and Dental Hygiene Educators Canada. However, these outcomes were stated in broad terms so it was often challenging to differentiate between diploma and baccalaureate education. Purpose: The aim of the study was to identify competencies for Canadian baccalaureate dental hygiene education and, in so doing, to clarify the boundary between diploma and baccalaureate education. **Methods:** A 3-round Delphi study was conducted with a purposeful sampling approach to obtain the views of Canadian dental hygiene experts. Participants were asked to rate each of the baccalaureate sub-competencies in terms of its “substantive difference” from diploma competencies using a 4-point scale ranging from “to a great extent” to “not at all.” They were also asked to rate their confidence in their responses. **Results:** Twenty-four dental hygienists met the inclusion criteria and were invited to participate in the online study; 10 respondents completed Round 3 representing a 42% response rate. The domains with = 50% of their sub-competencies rated as being substantively different (“to a great extent”) from diploma education were advocacy (100%), policy use (100%), research use (91%), health promotion (88%), coordination (63%), clinical therapy (56%) and oral health education (50%). **Discussion and Conclusion:** All the domains appear to make some contribution to the analysis of the differences between diploma and baccalaureate education. These data support the view that dental hygiene education reflects a continuum of gradually increasing abilities in domains that are central to diploma and baccalaureate education. The domains and associated sub-competencies identified as best explaining differences between diploma and baccalaureate dental hygiene education were advocacy, policy use, research use, and health promotion. Baccalaureate education was viewed as distinct from diploma education as these graduates gained abilities to work with groups, communities, and populations; to operate within a public policy and governmental context; and to provide services in diverse practice settings.

**Purpose:** Dental hygiene students may struggle with hand function performance during their training. Currently, there is no universal aspect of dental hygiene programs that screens for hand function issues, nor is there a protocol in place to help students who lack needed hand function skills. The purpose of this study was to examine whether hand function could improve with specific hand function exercises and whether any improvement would be evident in higher instrumentation scores as a result of hand function exercises. **Methods:** A convenience sample of 20 dental hygiene students consented to participate in this 6-week pilot study. At the start of the study, an occupational therapist tested the hand function of the participants using 4 occupational therapy evaluations, which tested the students’ dexterity, motor skills, and pinch and grip strength. The results were recorded, and the students began a focused, 6-week hand function exercise regimen. After 6 weeks the same 4 evaluations were performed and the pre- and post-test data were compared using both a dependent t-test and a simple ANOVA test. **Results:** Results revealed significant improvement in assessed hand function following the test exercises. Scores measuring the use of a periodontal probe and 11/12 explorer when compared to student scores from the previous 5 years showed no significant differences. Of the 20 students enrolled in the study, 3 students dropped out leaving 17 to complete the study. **Conclusions:** This study demonstrated that 6 weeks of specific hand exercises improved students’ hand function scores. However, this raised level of hand function did not carry over to increased instrumentation proficiency.

**Objectives:** Reducing oral health disparities has been an ongoing challenge in Canada, with those exhibiting the greatest need for treatment also having the poorest access to oral health care. Marginalized populations, including Aboriginal people, those residing in rural regions, immigrants and refugees, share the largest burden of oral disease in Canada. Dental hygienists are a unique set of health care professionals who work with and within these communities and have the potential to act as key change agents for improving the oral health of the Canadian population. The purpose of this qualitative study was to explore, from the dental hygiene perspective, the role of dental hygienists in reducing oral health disparities in Canada. **Methods:** Dental hygienists and key informants in dental hygiene were recruited, using purposeful and theoretical sampling, to participate in a non-directed, semi-structured one-on-one in-depth telephone interview. Corbin and Strauss’s grounded theory methodology was employed with open, axial, and selective coding used for analysis. Skype, Call Recorder, and N-Vivo Qualitative analysis software were utilized for this research. Results: The resulting theoretical framework outlines strategies proposed by interview participants to address oral health disparities. Approaches included alternate delivery models, interprofessional collaboration, and increased scope of practice. Participants identified that the variation in dental care across Canada, public perceptions of oral health and dental hygiene practice, and lack of applied research on effective oral health interventions were challenges to implementing these strategies. **Conclusion:** The research confirmed the important role played by dental hygienists in reducing oral health disparities in Canada. However, because of the fragmentation of dental hygiene practice across Canada, a unified voice and cohesive action plan are needed in order for the profession to fully embrace its role as a key change agent.

**Objectives:** Locally administered minocycline hydrochloride (LA-MHChl) has been effective in improving clinical parameters when used as an adjunct to scaling and root planing (SRP). The purpose of this study was to determine if LA-MHChl would support greater mean reduction in probing depth (PD), when used as an adjunct to SRP in HIV-positive, periodontally involved adults. **Methods:** Sixteen HIV-positive, periodontally involved adults (9 male, 7 female), ages 30 to 70 years, with a minimum of 2 periodontal sites equal to or greater than 5 mm, were recruited to participate in this double-blind, randomized clinical study. Qualifying periodontal sites for each subject were randomly assigned to either treatment or control: the treatment group received LA-MHChl in conjunction with SRP; the control group received no treatment beyond SRP. LA-MHChl placement was simulated to keep participants blind. The same examiner obtained baseline and follow-up measurements and was unaware of the treatment allocation. The same clinician performed SRP and LA-MHChl placement. Follow-up measurements were obtained at 3, 6, and 9 months. The change from baseline within each group was evaluated using the Paired-samples t-test with 95% level of confidence. The change in PD between the groups was evaluated using the Independent-samples t-test with 95% level of confidence. **Results:** Both treatment and control groups had a statistically significant decrease in PD from baseline at 3, 6, and 9 months. When a comparison was made between the groups, the average reduction in PD was statistically significant in the treatment group as compared to control at 3 months (1.27 mm +/-0.30 and 0.50 mm +/-0.20, respectively) and 9 months (1.94 mm +/-0.27 and 1.27 mm +/-0.22, respectively). Although the average clinical reduction in PD was greater in the treatment group as compared to control at 6 months (1.27 mm +/-0.19 and 0.94 mm +/-0.22, respectively), this decrease was not statistically significant. **Conclusion:** LA-MHChl used in conjunction with SRP produce a statistically significant reduction in PD in HIV-positive, periodontally involved adults when compared to SRP used alone.

**Background:** The high incidence of oral diseases and oral cancer in Pakistan, combined with a lack of timely access to care, the cost of dental treatment, a low perceived need for prevention, and an insufficient supply of qualified dental professionals, prompted the creation of a 2-year diploma in dental hygiene (DDH) program at Aga Khan University. Curriculum design began in 2013 led by a core team of Canadian dental hygienists, with contributions from other North American dental hygienists. DDH faculty were recruited in 2014; January 2015 marked the date for the first intake of students to the program. **Objectives:** The DDH curriculum prepares graduates to serve the urgent oral health needs of the population, particularly in marginalized rural regions, by providing educational, preventive, and therapeutic services, primarily for vulnerable populations which often do not have access to oral health care professionals. **Approach:** The program includes courses in dental hygiene theory and practice, oral health sciences, and an emphasis on community health, leadership, and interdisciplinary practice. The majority of the DDH program is delivered by international volunteer dental hygiene educators. DDH students are introduced to interdisciplinary education, with shared courses within the School of Nursing. **Evaluation:** Short- and medium-term program success will be evaluated by student and employer feedback, graduate employment data (e.g., urban versus rural, private versus public sector), curriculum evaluation processes, clinical oral health outcomes, and utilization rates. Long-term success of building local capacity will be measured by the development of an autonomous dental hygiene profession which will build its own dental hygiene capacity both in education and practice. The eventual success of the program will be demonstrated by a philosophical shift in the population from disease-oriented pain management to one of primary prevention.

**Background:** As ergonomics is to workplace (environment and tools in relation to the person), so functional fitness is to workplace wellness (person in relation to the work). For over 10 years, a dental hygiene program in Manitoba has included a weekly “fit to sit” laboratory within its pre-licensure curriculum. However, little attention has been given to functional fitness and the practising dental hygienist. The pre-licensure curriculum has 2 learning outcomes: to be functionally fit for practice with respect to ergonomics and to employ behaviour and motivation theories and strategies. It was this curriculum that was of interest to practising alumni who participated in a professional development session focused on self-care with respect to functional fitness, ergonomics, and the ability to provide quality client care. Following this session the educators who delivered the curriculum recognized a need to examine the concept of functional fitness and its value to dental hygiene practice. **Objective:** This project aims to 1) reflect on the meaning of functional fitness and its relationship to ergonomics and practice; 2) explore functional fitness as a requirement for practice; and 3) inform pre-licensure curricula and continuing competency programming. **Approach:** This case study focuses on the lived experience of 4 educators who have been involved in the planning and delivery of the curriculum. Knowing ergonomics has a long history of being integrated into the curriculum and practice standards, the key query was “What elements of functional fitness should the pre-licensure curriculum be accountable for and how are functional fitness and ergonomics related to continuing competency?” **Evaluation:** Three preliminary themes help to address both the praxis query and the objectives of the project: 1) evidence of functional fitness in dental hygiene practice is emerging; 2) practice standards promote health and wellness of the dental hygienist; and 3) pre-licensure curriculum and continuing competency programs that promote functional fitness in relation to ergonomics are beneficial to dental hygienists’ self-care and ability to provide quality care for clients.

**Background:** Oral cancer is the sixth most common malignancy worldwide, with two-thirds of cases arising in developing countries. In many South Asian countries, the incidence of oral cancer is nearly twice that found in Canada. Currently in British Columbia, nearly 10% of the population is of South Asian ethnicity. As a significant subgroup of the population, and considering their varied risk habits, it is crucial to understand the incidence of oral cancer in British Columbia’s South Asian population. **Objectives:** This retrospective study explores differences in oral cancer incidence among South Asians living in British Columbia compared to the general population. **Methods:** Data from the British Columbia Oral Biopsy Service (BC OBS) database in conjunction with the BC Cancer Registry are being examined to identify oral cancer cases. The inclusion criteria are patients diagnosed with squamous cell carcinoma (SCC) or carcinoma in situ (CIS) in the oral cavity. All data are cross-referenced for ethnicity using name recognition software. **Results:** In 2013, more than 300 cases of dysplasia and cancer were identified in British Columbia. Further analysis of the databases is ongoing. Preliminary results indicate that South Asians have a significantly higher number of lesions at sites considered low-risk in Western countries, including gingiva and buccal mucosa, than non-South Asians in British Columbia (p < 0.001, OR=5.9, CI 2.5–13.7). **Conclusion:** Results from this study will increase awareness of oral cancer in BC and identify population trends that reflect the ethnic diversity of our province. This study will also provide a basis for outreach programs to promote oral cancer awareness, as well as tailored screening and education among high-risk populations.

**Background:** Oral potentially malignant lesions (OPML) with evidence of dysplasia are at a higher risk of progressing to oral cancer. However, not all will progress, and predicting which low-grade dysplasia (LGD; mild/moderate dysplasia) are at risk of progression is challenging. Finding markers to predict which LGD will progress has the potential to guide the management of these lesions and improve patient outcomes. **Objectives:** This study aimed to 1) identify the clinicopathological changes in toluidine blue (TB) uptake, over time, in lesions with identified molecular risk patterns; and 2) determine if these changes predict malignant progression. **Methods:** A total of 231 subjects met the study’s inclusion criteria, including a histologically confirmed LGD, no previous history of head and neck cancer, and a minimum of one year of follow-up. Molecular data (loss of heterozygosity [LOH] at key chromosomal loci) were obtained using baseline biopsies. Comparative biopsies were collected approximately every 24 months. Demographic and clinical data, including TB positivity (TB+), were collected every 6 months. Outcome was considered to be progression to severe dysplasia, carcinoma in situ or squamous cell carcinoma. **Results:** Thirty subjects (13%) progressed to endpoint. Temporal analysis indicated that TB positivity within the first 2 years of follow-up was statistically significant for progression (p<0.001). Survival analysis of temporal TB+ patterns showed that subjects who were either intermittently TB+ or always TB+ had a higher likelihood of progression, as compared to those who were never TB+. LOH at 9p was significantly associated with progression (p = 0.001). Controlling for all other variables in the model, the combination of LOH at 9p and temporal TB+ was associated with malignant progression. **Conclusions:** The persistence or appearance of TB positivity in LGD during follow-up may signal a change in risk and may predict progression. LGD with high molecular risk (LOH at 9p) and a history of TB positivity are more likely to progress and should be biopsied at regular intervals.

**Background:** Older adults residing in long-term care (LTC) are at high risk for compromised oral health due to frailty and dependence on others for oral care. Several studies have cited significant barriers to the provision of oral care for older adults, including lack of knowledge among nursing staff, competing care needs taking greater priority, residents with care-resistive behaviours, assessments that do not identify oral problems, limited oral care supplies, and limited access to oral care services. Following substantial advocacy and professional relationship building between dental hygiene and LTC nursing in Manitoba, Revera Retirement Living took the initiative to pilot a new oral health promotion model in Beacon Hill Lodge, one of their LTC facilities in Winnipeg. **Objective:** To explore an innovative and collaborative strategy that integrates a part-time salaried dental hygienist into a LTC health care team to advance care approaches and improve the oral care of residents. **Approach:** The presentation will share the events that sparked the initiative, planning details, implementation strategies, and the findings from piloting a new interprofessional oral health promotion model over 12 months in a 175-bed LTC home. The project received ethics approval from the University of Manitoba and the Winnipeg Regional Health Authority. Funding for the pilot project was provided by Revera Long Term Care. **Evaluation:** Baseline data, oral health assessment tools, and nursing education and mentorship strategies were developed, implemented, and evaluated. Results of their use will be shared, along with a rich account of lessons learned. This innovative and collaborative project that brings together nursing and dental hygiene provides numerous lessons on quality improvement to advance the oral care of older adults in LTC.

**Background:** This study explored the influence of oral health literacy and oral health chronic disease knowledge on older adults’ oral care behaviours. **Methods:** A total of 73 community-dwelling adults, ages 50 or older, participated in an anonymous online study. The study utilized the Oral Health Literacy – Adult Questionnaire; the Oral Health Chronic Disease Knowledge Questionnaire; an oral care behaviours questionnaire; a background tool questionnaire; and 9 open-ended questions exploring dental care regime, dental visit frequency, perceived importance of oral health in relation to overall health, and search frequency, comprehension of, and main sources for oral health information. **Results:** Approximately 95% of study participants scored at the adequate level of oral health literacy. In contrast, only 38% of participants scored at the adequate level of oral health chronic disease knowledge. About 52% of participants reported brushing 2 or more times per day, 25% reported using no type of interdental aid, and 33% reported flossing less than daily. Preliminary Chi-square analysis revealed a significant relationship between frequency of dental visits and adequate levels of oral health literacy and oral health chronic disease knowledge. Qualitative results showed that, while older adults believe that a healthy mouth is part of a healthy body, many do not actively search for oral health information, preferring instead to rely on dental professionals to supply this information. **Conclusions:** This sample of community-dwelling adults in midlife and older exhibited higher levels of oral heath literacy than oral health chronic disease knowledge. Oral health literacy and oral health chronic disease knowledge were not significantly related to all oral care behaviours. **Practice Implications:** Oral health professionals need to provide older adults with information about the association between oral health and chronic disease.

Letters to the Editor

Letters to the editor

**Background:** The Canadian Dental Hygienists Association and Dental Hygiene Educators Canada created learning outcomes for baccalaureate education in the early 2000s. However, further development to inform members of the profession, other professionals, and the public as to what they can expect from baccalaureate dental hygiene graduates was deemed necessary. **Purpose:** The aim of this study was to identify the competencies that Canadian dental hygienists need at the fourth-year baccalaureate level to promote and support the oral health of the public. **Methods:** An online, 3-round Delphi study was conducted from fall 2012 until spring 2014. Respondents were asked to rate the importance, relevance, and realistic characteristics of domain competencies and their sub-competencies. Open-ended questions were included to augment the ratings. A 70% consensus level was selected for inclusion of the competencies. **Results:** Twenty-four Canadian dental hygienists who met the inclusion criteria were invited to participate in the study; 10 completed Round 3 representing a 42% response rate. Round 1 started with 14 domain competencies supported by 120 sub-competencies. This number was reduced by Round 3 to 13 domain competencies and 98 sub-competencies. Several domain headings were identical to the national entry-to-practice domains: professionalism, coordination, advocacy, health promotion, oral health education, and clinical therapy. The domains of collaboration and communication were uncoupled and articulated as separate entities, and new domains were added: research use, leadership, policy use, disease prevention, and knowledge of discipline. **Discussion and Conclusion:** Consensus was achieved on a diverse number of domain competencies and sub-competencies; many are similar to the competencies from diploma education but expressed to a higher level. Others highlight the importance of discipline knowledge, research use, policy use, and leadership. These competencies have the potential of being valuable for accreditation, national examination as well as educational purposes; they may serve as a catalyst for strengthening baccalaureate dental hygiene education.

**Background:** Toothbrushes should be replaced every 3 to 4 months as older brushes lose their plaque removal ability. Older brushes may not be able to remove plaque from pits and fissures seen on the occlusal surfaces of the teeth or from the proximal areas between the teeth. The purpose of this study is to evaluate the wear seen on used toothbrushes (UTB) and the relation of wear with regards to the period of toothbrush use. **Material and methods:** UTB were collected from university students studying courses in arts and sciences faculties, excluding health sciences faculties, during an oral health awareness campaign conducted by the Faculty of Dentistry. A validated questionnaire was used to collect descriptive data regarding toothbrushing habits. Two calibrated examiners scored the UTB according to the Rawls et al. index. Authors also examined different types of toothbrushes and the cleanliness of the toothbrush handles. **Results:** The findings of the study show that 58.0% of the UTB were in good condition for optimal plaque removal (scores 0 and 1), whereas the remaining 42% were not in suitable condition for optimal plaque removal (scores 2 and 3). The UTB measured with Rawls et al.’s index were used for 2.7, 4.5, 5.9, and 7.0 months (mean number of months), respectively. **Conclusion:** Many factors, in addition to period of use, come into play with regards to the splaying of toothbrush bristles. Dental professionals should educate their clients about and reinforce the need to replace toothbrushes after 3 to 4 months of use or after significant wear of the bristles, whichever comes first.

Human papillomavirus (HPV)-associated oropharyngeal cancers are projected to increase at significant rates in the next few decades. With information on the natural history and carcinogenesis of HPV still at a young stage, more research is necessary. This study investigated the prevalence of 2 high-risk HPV types in a dental student clinic setting in order to give oral health professionals a broad picture of oral HPV infection. Real-time polymerase chain reaction (PCR) was used to detect HPV types 16 and 18 in 110 oral rinse samples. Only one sample was positive for HPV, specifically type 18. We conclude that high-risk HPV prevalence is very low in a dental student clinic setting.

Letters to the Editor

**Introduction:** Better methods and protocols must be developed to perform proper daily mouth care for geriatric residents in long-term care (LTC) facilities. A practicum was initiated in which senior dental hygiene students worked at 2 LTC facilities to provide daily mouth care for residents, conduct oral health (OH) assessments, and when possible, provide OH care instruction to health care aides (HCAs) and other staff. In-service educational sessions were also provided to LTC staff by two registered dental hygienists. This article provides results of the oral assessments and results from the interviews. **Methods:** Oral assessment data were collected from residents using a modified version of the Oral Health Assessment Tool (OHAT). At the end of the practicum, individual interviews were conducted with HCAs, RNs, education coordinators, and executive directors at the LTC facilities. **Results:** Residents had poor oral health: 20.4% had healthy oral cleanliness, 12% had healthy tongues, and 38% had healthy gums and tissues. Most residents had generalized plaque (63%) and generalized hard debris (50%). Sixty-three percent of residents required some or total assistance with mouth care. Analysis of interview transcripts identified the following themes: 1) minimal to no interaction between staff and dental hygiene students; 2) positive feedback for student presence; 3) minimal mouth care training of facility staff; 4) regular mouth care routine done twice daily; 5) problems with administering mouthcare to residents; 6) lack of awareness of new Edmonton Zone mouth care guidelines; 7) plans for administrative staff to address follow-up to student oral health recommendations. **Conclusion:** This study further confirmed that improvements must be made in the provision of daily mouth care in LTC and that ways to effectively incorporate and involve students with the daily routine in LTC facilities must be examined.

**Introduction:** Health and oral health disparities in the Aboriginal population are well documented. While the underlying causes of these disparities are complex, the purpose of this literature review is to examine the possibility that delivering oral health care that is not culturally safe may be contributing to such disparities. **Methods:** A systematic search was completed using PubMed, CINAHL, Medline, and Google Scholar. The results were few, therefore more key search terms were added and an advanced search through Summon was conducted. The studies selected were assessed using the Critical Appraisal Skills Program appraisal framework for qualitative research. Discussion and **Results:** Health care providers’ perspectives about Aboriginal peoples are influenced by a complex set of ideologies. Narrow cultural assumptions intertwined with dominant social stereotypes conflict with professional egalitarian ideals, affecting the delivery of equitable services. The tendency of health care providers to ignore the wider sociocultural and political context of health care encounters leads to attitudes and behaviours that are perceived by Aboriginal clients as discriminatory, demeaning or disempowering. **Conclusion:** Attitudes and assumptions of oral health care providers towards Aboriginal people may unknowingly and unintentionally contribute to the inequitable provision of oral health care services, ultimately leading to poor oral health outcomes among this population. Integrating cultural safety into oral health care has the potential to reduce such disparities and ultimately contribute to the improvement of the oral health of Aboriginal peoples in Canada.

**Background:** Canada is becoming increasingly culturally diverse. Evidence indicates that certain cultural groups, such as new immigrants and refugees, Aboriginal people, and people of low economic status experience health (including oral health) disparities as well as unequal access to care. Improving cultural competence (CC) within the health care professions has been identified as a strategy to help reduce health disparities. However, there appears to be a lack of awareness of the importance of CC in health care and how it can be consistently and effectively taught. This pilot project was undertaken to explore the views of and challenges experienced by dental hygienists practising in a multicultural society. **Methods:** A focus group was conducted with 5 dental hygienists to explore their understanding of CC and their experiences in caring for clients of different cultural backgrounds. Interpretive analysis was conducted to identify major themes within the transcript of the discussion. **Results:** The major themes that emerged from the analysis were the meaning of culture; the meaning of CC; the difficulties of practising CC; education needs related to CC; CC in oral health care education. **Conclusion:** Cultural competence and how it can be effectively practised was not well understood by the participants, indicating that, similar to other professions, dental hygiene may need to re-examine how this complex topic is delivered in undergraduate dental hygiene education and how the profession can ensure that continuing education on this important topic is provided. Education focusing on the social determinants of health and power imbalances in society may aid in this re-examination.

**Background:** Older adults are more likely than any other segment of the population to have poor oral health and tend to utilize dental care services less frequently than their younger counterparts. Despite various investigations to identify key predictors of dental care utilization among older adults, the influence of social support on their use of dental care services remains unclear. The purpose of this investigation was to explore the relationship between social support and regular use of dental care services among independent dwelling older adults in Canada. **Methods:** Data on dental care utilization from 13,134 individuals (ages 60 or higher) residing in British Columbia and Ontario were drawn from the Canadian Community Health Survey and analysed using hierarchical logistic regression. **Results:** While the study found that being married and having a stronger sense of community belonging increased the likelihood of regularly visiting a dentist, living with others produced mixed results. Additionally, the impact of living arrangement on dental care utilization was specific to gender and denture use. **Conclusion:** These findings indicate that, while social support does play an important role in dental care utilization, its role is much more complex than is noted in the literature and warrants further consideration in oral health promotion initiatives.

Dental hygiene scholarship development exists on a continuum. At one end, scholarship begins in entrylevel dental hygiene programs and then progresses to higher levels of scholarship in research-oriented master’s degree programs and in research-oriented doctoral degree programs that require learners to conduct original independent research.1 Although nursing, physical therapy, and audiology have developed doctoral programs to prepare graduates to engage in discipline-specific research,2-4 to date there are no US dental hygiene doctoral programs. The question needs to be asked: Why is dental hygiene so far behind other health professions in establishing doctoral programs to conduct rigorous discipline-specific research? Could it be that dental hygienists are not fully aware of the discipline’s hierarchy of knowledge and of the importance of developing a scholarly identity related to it?1 Could it be that there are maladaptive patterns of behaviour among dental hygienists that create roadblocks to moving the discipline forward, of which we are unconscious? And, if these threats are real, then what can be done to counteract them? The purpose of this paper is to challenge our thinking about these questions and to provide some essential information to consider in answering them. Specifically, this paper will discuss 1) the dental hygiene discipline’s hierarchy of knowledge; 2) the dental hygiene scholarly identity and its importance to the discipline’s advancement; 3) the “imposter” phenomenon5,6 and the “queen bee” syndrome7 as roadblocks that may jeopardize our discipline’s ability to move forward; and 4) the role of “followership”8 in diminishing these potential roadblocks.

Tobacco is the only legal consumer product that kills at least 1 out of 2 of its regular users when used as intended by the manufacturer.1 There are approximately 1.1 billion smokers worldwide, and it is predicted that the use of tobacco could kill 1 billion people during the 21st century. Cigarettes contain tobacco, and tobacco contains nicotine, delivered rapidly to the brain when smoking tobacco. Nicotine is a single psychoactive substance that affects the brain and the central nervous system, among others. The disease of tobacco addiction (nicotine dependence, tobacco use disorder) is recognized as a chronic disease by most authorities including the United States Department of Health and Human Services (USDHHS), Health Canada, many countries’ medical associations, and the World Health Organization; it is identified as such in major disease classification systems.2,3 However, not every person who uses tobacco is addicted to nicotine.

An evidence-based approach to health care officially started in the early 1990s with leaders such as Drs. David Sackett and Archie Cochrane, although roots of this movement can be traced to earlier times. This approach has continually been implemented in all areas of health care, including dentistry. The American Dental Association (ADA) definition of evidence-based dentistry can be adapted as “an approach to oral health care that requires the judicious integration of systematic assessments of clinically relevant scientific evidence, relating to the patient’s oral and medical condition and history, with the dental care professional’s clinical expertise and the patient’s treatment needs and preferences.”1 This definition includes the 3 critical realms: the science, the clinician’s judgement, and the individual patient’s needs and preferences. Using evidence-based decision making (EBD) provides specific and individualized health care that is based on the most robust scientific evidence. Much debate has occurred around the role of each of these realms, but Dr. Sackett described it best when he said, “External clinical evidence can inform, but can never replace, individual clinical expertise.” Dr. Victor Montori, another leader in the evidence-based health care movement, gave a clear assessment of the role of research when he stated, “The better the research, the more confident the decision,” but he also stated that “Evidence alone is never sufficient to make a clinical decision.” The key take-home message is that evidence and science inform, but never replace, clinical decisions. Learning how to use evidence in making health care decisions is a acquired skill that is perfected over time. As illustrated in Figure 1, there are 5 steps in applying EBD. This paper will review these 5 steps and will offer insights into how to obtain the skills necessary to successfully implement each step.

A note from the book review editor Each year many books applicable to dental hygiene practice are published and no one dental hygienist can read them all, yet each book may contain information important to his or her professional development. Book reviews in the Canadian Journal of Dental Hygiene (CJDH) are one way for members of the Canadian Dental Hygienists Association and other oral health professionals to discover what publications are available and to efficiently choose which books to read. In January 2014, I joined the CJDH editorial board as its first book review editor, taking on the responsibility of requesting and receiving titles from publishers and soliciting reviews from experts in the field. Expertise may be defined broadly: the reviewer may be a published author in the field or may have extensive practical experience relating to the subject or themes presented in the book. If you are invited to review a book or books for the journal, you will be given clear guidelines on the type of review to prepare. Typically, CJDH book reviews are brief, lively, and considered a critique. While they may vary in tone and style, they all share common features: 1. an introduction to the book, author, and topic; 2. a concise overview of its contents, including general problems and concepts that the book addresses, as well as a relevant description of the thesis and evidence supporting it; 3. a critical assessment of specific sections of the book and the reviewer’s reactions to the book as a whole: what is noteworthy, whether or not it is effective or persuasive, and how it enhances understanding the topic or issues at hand. Does it achieve its objective? Are there factual errors or omissions? Does it contribute to the field? Is the book unique?; 4. a recommendation on who would best appreciate the book. This issue of the journal marks the official launch of our new book review section, with the publication below of a review by two dental hygiene colleagues from British Columbia. I hope you enjoy what they have to say.

Letters to the Editor

Objective: The Healthy Smile Happy Child (HSHC) initiative has promoted early childhood oral health in Manitoba, Canada. The purpose of this study was to understand service provider, parent, and caregiver views on oral health promotion in Manitoba to inform future work. Methods: A qualitative descriptive study design using focus groups was used. Three groups included non-oral health service providers and three included parents and caregivers of young children. Discussions were audio-recorded, transcribed, and then analysed for content into themes. Results: Overall, 25 service provider and 25 parents and caregivers participated. Emerging themes included how participants learned about early childhood oral health, the gap between oral health recommendations and reality, and the need for recommendations to be practical and realistic if they are to change behaviours. Both groups expressed difficulty in locating dentists willing to care for young children despite dental professional recommendations for early first visits. Several recommendations for promoting early childhood oral health were provided by service providers, parents, and caregivers. Conclusions: Overall, participants felt that the HSHC initiative and resources were useful and effective in promoting early childhood oral health. Findings from this study have been used to refine community development health promoting activities and will inform the development of new strategies.

Plaque accumulation on the interproximal surfaces of the teeth can initiate periodontal disease and caries. For removal of plaque from interproximal surfaces, dental floss is recommended by oral health practitioners. However, advice on flossing is usually not well received and followed by the client. Objective: This study sought to identify the most common causes for non-usage of floss among the dental student population in Kanti Devi Dental College and Hospital, Mathura, India. Methods: A total of 404 dental students were segregated into flossers and non-flossers. A questionnaire on the causes for non-usage of floss was administered to the non-flossers, who were asked to select the 2 most appropriate causes for non-usage of floss. Results: Of the 404 dental students, 287 were non-flossers and 117 were flossers. Among 287 non-flossers, 62 students (21.6%) chose “never been introduced to the habit of flossing by my parents” and “I feel my mouth is clean after brushing” as the most common combination of causes. Conclusion: The findings of this study suggest that dental students in Mathura are using floss to a very limited extent. Hence, the inclusion of advice on flossing in the oral hygiene instructions to their clients is also limited. In order to increase the awareness of flossing in the general population, efforts have to be made to better instill the importance of complete oral hygiene, which includes flossing, in the dental student population.

Between January 2010 and July 2011, a registered dental hygienist and Registered Nurses’ Association of Ontario (RNAO) best practice coordinator set out on a journey to improve the outcomes of oral care for residents in a long-term care (LTC) home in rural Ontario. Using evidence-based oral care resources developed by the RNAO, the quality improvement team created an education intervention for LTC staff and monitored their progress in providing oral care to the residents. The initiative was marginally successful in achieving its primary objective of improving oral care but this outcome was negligible in light of other oral/dental health issues and documentation discrepancies. This article shares findings and discusses challenges encountered along this quality improvement journey, and suggests next steps to improve the delivery of oral care for residents of LTC homes.

Objective: This article reviews risk factors, stress issues and symptoms, coping strategies, and resources for Canadian registered dental hygienists, and answers the question, “How can clinical dental hygienists recognize and manage stress symptoms in order to prevent professional burnout?” Method: A search of peer-reviewed and non-peer-reviewed literature published between 1990 and 2013 was conducted. Thirty-one publications were cited, including quantitative and qualitative studies pertaining to dental hygienists, health care workers or organizational employees. Statistics from government sources were added for information purposes. Results and Discussion: Occupational stress is one of today’s leading public health issues. Many government agencies have addressed the detrimental effects of occupational stress on individuals and health care systems. Dental hygienists are at particular risk of suffering from compounded work and life stress, and burnout. There seems to be a lack of stress management education in dental hygiene curricula. To prevent burnout among dental hygienists, there is a need for increased awareness. Further research on occupational stress specific to dental hygienists is also warranted. Conclusion: Dental hygienists can combat stress and prevent burnout through increased awareness of risk factors, symptoms, and effective coping skills.

On February 25, 2014, the Canadian Dental Hygienists Association (CDHA) Board of Directors endorsed the following position statement on interdental brushing and the practice guideline, “Interdental Brushing or Flossing: Self-Care Recommendations for Clients with Interdental Inflammation.”

Almost two-thirds of oral cancer patients are diagnosed at a late stage, leading to extensive treatment and low survival rates. Dental hygienists have frequent contact as oral care providers for oral cancer survivors and should have a basic awareness of the various treatments for oral and oropharyngeal cancer. Objective: The aims of this article are twofold: 1) to describe the 3 main treatment modalities for oral squamous cell carcinoma (SCC) and their associated side effects; and 2) to assist the dental hygienist in client education. Method: Articles reviewed include those on the treatment modalities of oral cancer published since 1992, retrieved from databases such as Google Scholar, PubMed, and ScienceDirect. Results and Discussion: The extent and type of therapy are weighed according to individual patient risk factors, tumour features, and the effects that treatment might have on the patient’s quality of life. Single treatment modalities such as surgery and radiation alone are more commonly provided for early-stage cancers, while patients with advanced disease are treated with a combination of 2 or all 3 of the treatment modalities: surgery, radiation, and chemotherapy. Conclusion: With improvements in oral cancer treatment, there has been a significant increase in local–regional disease control and overall survival rates. Despite these results, there is still a need to coordinate care between specialists and primary care providers to ensure that both oral and overall health needs are met and to reduce the risk of recurrence and the emergence of second primary tumours.

Dental hygienists, by virtue of their recare schedule, may have the most frequent contact with the cancer survivor. The effects of cancer continue long after the patient completes treatment, and the sequelae of cancer treatment can often be debilitating. The dental hygienist plays a valuable role in the multidisciplinary health care team that follows a head and neck cancer patient. Objective: The objective of this article is to provide dental hygienists with a brief overview of the effects of cancer treatment on dental clients and the role of the dental hygienist both prior to and after treatment, with particular focus on head and neck cancers. Methods: A review of the oral cancer literature in PubMed and Google Scholar on dental care before and after treatment was conducted and included articles published since 1998. Results and discussion: Oral cancer survivors have difficulty eating, speaking, and swallowing as a result of treatment. Radiation therapy presents the most challenges, with patients suffering from hyposalivation, tissue changes, osteoradionecrosis, radiation caries, and an increased risk of clinical attachment loss. Chemotherapy may cause mucositis of the oral cavity and GI tract. Education and treatment prior to cancer therapy can minimize some treatment effects. Conclusion: Dental hygienists provide services that can both prevent and aid in the management of the oral complications of cancer treatments. It is important that dental hygienists be aware of and understand the methods for care of these patients.

Objective: To increase awareness among dental hygienists of the use of waterpipes (WPs) and their associated risks. Methods: A literature search of studies published between 2000 and 2013 that examined the belief that WPs are “harmless,” the risks associated with WP use, and the shortterm and long-term health effects of WP smoking was conducted. Historical papers and gray literature were also reviewed to confirm the findings. Results and Discussion: The prevalence of WP smoking is on the rise in North America, especially among young adults who may view it as “harmless.” WP smokers may be exposed to 3 to 9 times the carbon monoxide and almost 2 times the nicotine of a cigarette after a single 1-hour WP session. Sharing WPs may lead to the transmission of communicable diseases such as herpes, hepatitis, and tuberculosis. WP smoking is also shown to be associated with an increased risk of lung cancer, respiratory illness, and low-birth-weight infants for smokers and may be a gateway to nicotine addiction. The US Food and Drug Administration and the Canadian Food Inspection Agency do not regulate WP packaging, contributing to the lack of standardization of WP contents. Conclusion: Dental hygienists need to be aware of the lack of regulations and how this may lead to public misconceptions about WP smoking as a “safe” or “harmless” activity. There is a significant need for in-depth scientific investigation and dissemination of knowledge concerning WP use in order to understand its health effects, to guide cessation efforts, and to shape public policies.

Dental hygiene clients with persisting oral lesions may need to be referred for further follow-up and possible management. These clients may experience anxiety regarding the biopsy procedure and may ask the dental hygienist for additional information. An informed dental hygienist will be able to provide the necessary information to the client to reduce stress and may feel more comfortable referring, thereby decreasing any potential diagnostic delay. The objective of this article is to increase awareness among dental hygienists of how a biopsy is performed, processed, and diagnosed.

For many people, the word “biopsy” is directly associated with cancer. Yet a biopsy is often the only way to diagnose a variety of conditions and diseases, and the oral cavity is no exception. Discussing the need for a referral or biopsy for a suspicious lesion can be challenging for the clinician. The objective of this article is to provide the dental hygienist with some examples of how to talk with a client about referral and biopsy.

A comprehensive examination of dental clients by dental professionals, including extraoral and intraoral soft tissue examinations, has the potential to make a difference in the rates of early detection of oral cancer. Dental hygienists have the training to assess oral soft tissues and differentiate between normal, healthy tissues and abnormal or diseased tissues. The dental hygiene appointment is naturally predisposed to opportunistic oral cancer screenings as part of routine dental hygiene care. Practice standards dictate that dental hygienists have a professional responsibility to conduct systematic, comprehensive assessments of the head, neck, and oral cavity and to document changes. When an abnormal lesion persists for more than 3 weeks, the appropriate referral pathway should be initiated. Changes to regulations and increased scope of practice also have the potential to maximize access to oral health care for Canadians. Increasing access points to care and screening outside of a traditional office setting may specifically benefit vulnerable and underserved populations.

2013; 47, no.4: 157–158 157 E D I T O R I A L The valuable role of the literature review Katherine Zmetana, DipDH, DipDT, EdD It can be pretty much agreed that research is critical to evidence-based practice and that it is integral to the profession’s image, credibility, and ability to grow. Many types of research—qualitative and quantitative—have made a contribution to dental hygiene in their own way. And many research questions have yet to be explored. Before any research project can be undertaken, however, a review of the literature is necessary. This preliminary step is essential in understanding the broader context of the subject area, examining the research that has already been done, and identifying gaps that exist. The literature review directs the path of research—establishing focus and limitations, determining methodology, and clarifying purpose or applications. Such characteristics describe the “traditional” literature review, long established as the foundational stage of all academic research, whether in the domain of philosophy, science, education or dental hygiene. To be considered valid or trustworthy, literature reviews, as with all research, must be conducted with rigour. That is, they must be undertaken in a thorough and well-defined process with clear parameters. Nevertheless, the interpretation, analysis, and summary of the collected information are somewhat subjective, dependent on the researcher’s own perspective and purposes of investigation. Moreover, the process of investigation (for example, the choice of databases and number of articles selected) is also directed or at least supported by the lead investigator or supervising professor of the larger research project. Therefore there is no one standard or universally accepted methodology of the traditional literature review: it is highly dependent on topic, researcher, and supervising researcher. Thus, to many in the academic or scientific world, the traditional literature review is not considered, in itself, stand-alone research. Indeed, literature reviews provide a summary of secondary sources; they are not a report of original, experimental work. They do not present anything new that hasn’t been already researched. For this reason, there is often debate around the objective value of literature reviews, and whether they should be published as independent articles in scientific journals. It is important, then, to take into consideration the intended audience of the journal as well as the purposes of the literature review. For some journals, what may be considered more “scientific” is the systematic review, which follows a specific methodology in selection, review, and interpretation of scientific studies. The standards guiding the methodology, such as those supported by the Cochrane Collaboration,1 are internationally recognized. The purpose of a systematic review is to sum up the best available research on a specific question. This is done by synthesizing the results of several studies using statistical analysis. “A systematic review attempts to identify, appraise and synthesize all the empirical evidence that meets prespecified eligibility criteria to answer a given research question.”1 Researchers are rigorous and explicit in their methods of review; they follow a standard set of stages and requirements in user involvement to ensure that their study can be replicated. In effect, they analyze the effectiveness and reliability of the published (and sometimes unpublished) research on a specific research question.2 Because a systematic review is heavily weighted in favour of quantitative research and statistical analysis, its conclusions are considered unbiased and generalizable. Therefore it is often seen to have merit as an independent source of validated scientific evidence. Another type of literature review that follows a protocol (with standardized methodology under development3) is the scoping review. This review is a “rapid gathering of literature in a given policy or clinical area where the aims are to accumulate as much evidence as possible and map the results. [Scoping reviews] provide an overview of the type, extent and quantity of research available on a given topic. . . . and do so by using systematic and transparent methods.”4 The scoping review is not narrowly focused on studies using identical research protocols; rather the intent is to scope out the existing research and look for recurring themes within the literature to determine the current state of research in that particular area of study. While the systematic review focuses on a well-defined question and measures results, a scoping study tends to address broader topics where many different study designs might be applicable.5 The traditional literature review, in contrast, provides a more qualitative interpretation of available information. It covers a more general range and often serves as a knowledge translation piece, which is ideal for such an area as education.6 “In educational research, CTHoIrSr eISsp Ao nPEdEeRn RceE VtIoE:W DErD. K AaRthTeICriLnEe. Zmetana, Scientific Editor, CJDH; ScientificEditor@cdha.ca Scientific Editor, CJDH 158 2013; 47, no.4: 157–158 E D I T O R I A L where the methods of inquiry are more varied than in medicine [or pure science], there is greater flexibility in making decisions about literature survey methodology.”3 That brings us back to the question of determining which types of literature review, if any, should be considered for publication in a professional journal. In the case of the CJDH, we believe that all literature review methods offer a set of tools when used and applied appropriately. All forms of literature reviews—traditional, systematic, scoping—have valuable and unique roles. A systematic review can confirm or disprove a specific intervention, such as the use of interproximal brushes or different applications of fluoride. A scoping review can relate the current state of research in a particular area and determine where more study may be needed, such as the use of lasers in dental hygiene. Traditional literature reviews provide readers with easy access to current, relevant, and meaningful research on a particular subject by summarizing articles in one complete report for a common base of understanding. An example of this would be an article on the known causes of oral cancer. All forms of literature review provide an excellent starting point for discussion with colleagues and clients or researchers who are interested in original research. For that reason, they are all worthy of publication in our journal. Literature reviews are invaluable learning tools that can be shared. They enable us to embrace and practise common goals of a professional community that may include: • evaluating research in a particular area of interest • encouraging research among members • sharing knowledge with others • re-examining the way we think about things • making connections between ideas, theory, and experience • developing skills in research, critical thinking, and writing • gaining a worldview of professional practice The CJDH aims to provide current, relevant information on topics of particular interest to clinical dental hygienists and educators as well as researchers. It is a venue to nurture, support, and promote dental hygiene research within the professional community and without. Literature reviews serve those purposes well. This issue features two excellent literature reviews among other offerings. Susan Badanjak has written a comprehensive overview of the emerging field of salivaomics (p. 167). Sabrina Lopresti, Deanna Ngo, and Jennifer Tocchio have written a review on methamphetamine use and oral health (p. 176). The short communication by Sharon Compton, Minn Yoon, and Joanne Clovis reviews the insights and recommended actions resulting from an interprofessional symposium on age-related oral health care (p. 189). In addition, Caroline Jiang and Michael MacEntee explore the implementation of a government regulation on oral health care in long-term care facilities in British Columbia through interviews with administrators and health authority inspectors (p. 182). Finally, our new CDHA president, Mary Bertone, has written an editorial on the many aspects of leadership (p. 161).

**Objective:** This study investigated whether the Resident Assessment Instrument–Minimum Data Set (RAI–MDS) 2.0 is capable of predicting dental need in a sample of elderly long-term care (LTC) residents. The RAI–MDS is conducted by nursing staff and is designed to address LTC residents’ needs and to facilitate the development of care plans. Therefore, it is important to know if the dental and oral health components of this assessment provide accurate and valuable information. **Methods:** Chart reviews were conducted comparing RAI–MDS data with onsite dental assessments. Assessments collected from 2008–2012 on residents aged 65 years and older were used. **Results:** A total of 332 assessments were used for comparison in the study. Early data analysis reveals discrepancies in assessments conducted by nursing staff and the dental professional. The prevalence of moderate to severe gingivitis recorded by the dental professional was 74% compared to less than 1% prevalence of inflamed gums recorded by the nursing staff on the RAI–MDS. The RAI–MDS data showed negligible documentation of orofacial pain, and significant differences were found in recording the residents’ state of dentition. Although RAI–MDS data show that daily care is being performed, the oral health status of the population, determined by the comparative dental assessments, is still very poor. Individual dental RAI–MDS items that are expected to suggest treatment need, such as orofacial pain and caries, do not show any significant association with the dentist’s identification of treatment need. **Conclusion:** There is a need to elevate awareness of the oral health of older adults, especially those residing in LTC facilities who may be dependent on others for oral care provision and be susceptible to poorer oral health. The current use of the RAI–MDS does not appear to be useful in identifying individuals in need of dental treatment, indicating that a more effective assessment process is required. The results from the current study support the need to develop a sensitive oral health assessment tool, which can identify those individuals who require attention.

Purpose: This literature review examines the discipline of salivaomics in the oral environment and beyond as a diagnostic tool for disease. Its purpose is to acquaint dental hygienists with the science of salivary diagnostics and examine how it is currently being used for both intra- and extra-oral pathologies. Salivaomics or salivary diagnostics, a subset of molecular diagnostics, has moved to the forefront of disease detection, as most of the biomarkers found in blood and urine can also be detected in saliva. Methods: A PubMed search of articles published in English, between 2009 and 2013, was conducted. These articles were cross-referenced, verified for the chronological restriction and duplication; those not meeting these criteria were eliminated. The majority of the articles retained were review articles, which was expected, as salivaomics is an emerging field. Results: A growing body of literature supports salivary biomarkers as credible, measurable, and quantifiable biological indicators. Approximately 73% of salivary proteins are not present in plasma, making saliva an excellent diagnostic medium. Saliva can be used to screen, detect, diagnose, stage, and monitor disease and treatment outcomes. The saliva testing process is safe, in terms of reduction of needlestick injuries, simple, rapid, noninvasive, painless, reliable, complementary, and cost-effective. Conclusion: The emerging field of salivaomics will continue to play an increasingly important role in the diagnosis of oral and systemic disease. Its real-time and point-of-care advantages and its potential to reduce diagnosis-to-treatment time will revolutionize health care delivery.

Objective: This article reviews management and treatment considerations for dental hygiene clients who are suffering or recovering from methamphetamine addiction. Methods: A search of peer-reviewed and nonpeer- reviewed literature was conducted. Databases selected included PubMed, MEDLINE, Ovid, Google scholar, and UBC e-journals/resources. A total of 37 articles and websites, published between 1999 and 2013, were cited. Inclusion criteria incorporated qualitative and quantitative studies from 1999–2013; articles published prior to 1999 were excluded. General drug use statistics were added to provide background information. Results and Discussion: Methamphetamine (MA) use is on the rise, and an increasing number of MA-using clients are presenting for dental care. In order to provide optimal care to these clients, dental hygienists must improve their understanding of MA use and its devastating effects on oral health and overall health. Prevalent issues among MA users include cerebral/systemic effects of the drug, hyposalivation, xerostomia, decay, erosion, bruxism, malnourishment, and violent behaviour. Recognition and management of these issues will improve the care that MA users and recovering addicts receive, and also provide opportunities for referrals to substance abuse centres. Conclusion: Oral health care professionals can improve the delivery of oral health care services to MA users or recovering addicts by recognizing signs of MA use and employing appropriate management considerations.

Objective: To explore how a government regulation on oral health care in long-term care (LTC) facilities has been implemented in British Columbia (BC). Introduction: In 2009, the Government of BC enacted a regulation confirming the joint responsibility of dental professionals and administrators of LTC facilities for the oral health care of LTC residents. This regulation was intended to direct attention to the apparent widespread neglect of oral health of the residents and to improve oral health care in the facilities. Methods: Open-ended interviews with two health authority inspectors and five LTC administrators were conducted to determine how the regulation has been implemented in the facilities. Observational notes were made before and after each interview, and participants were selected purposefully to obtain a range of experiences and opinions on the implementation process. The relationships among the various perspectives were analyzed thematically by a constant comparison of responses. Results: Two major themes emerged from the interviews: 1) inspection by government officials; and 2) the administrators’ perception of oral health care. Inspectors explained that government wanted LTC residents to be examined at least annually by dental professionals. For the most part, however, inspectors do not assess oral health care unless there are complaints from dental professionals or a formal complaint to government. Administrators generally seemed unfamiliar with the regulation, and did not expect that oral health care would be part of the government inspection. Conclusions: The regulation on oral health care in LTC facilities in at least two health authorities in BC is not achieving its objectives because health authority inspectors do not usually inspect the specific oral health care practices of the facilities.

Oral care for older adults, particularly those in long-term care, is increasingly gaining national attention as needs and potential solutions are identified among health care providers across Canada. Interprofessional research, education, and practice are needed to implement and sustain strategies and policies that promote best practices for older adult oral care. A national symposium held in Edmonton, Alberta, in November 2012 provided an opportunity to discuss older adult oral health from a multidisciplinary perspective so that common ground might be established and shared publicly. Invited participants were from a range of roles and professions, including dental hygiene, dentistry, nursing, medicine, occupational therapy, and nutrition. Presentations informed small group discussions which focused on 6 areas of action, identifying challenges and potential solutions. Specific recommendations were made regarding each of the 6 action areas. Continued dedication and leadership will support the development of the symposium network to realize the action recommendations.

Introduction: In March 2012, British Columbia’s Ministry of Health approved a new registration category for dental hygienists. The associated College of Dental Hygienists of British Columbia bylaw included 4 competencies that registrants were required to meet at the 4th-year baccalaureate degree level. Purpose: To identify the differences, if any, between diploma and baccalaureate degree education with regard to the 4 legislated abilities. Methods: An online survey including closedand open-ended questions was conducted with registrants who had entered practice with a diploma and then earned a baccalaureate degree. This article focuses on the quantitative data arising from the survey. Results: A conservative analysis of available data suggests the study had a 51% response rate (n=123). Fifty per cent or more of the respondents indicated that their abilities in each of the 4 required competencies had improved as a direct result of their baccalaureate education. The improved ratings ranged from 50% to 89% with the abilities in critical thinking, problem solving, and research use being rated as the highest areas of change. Two statistically significant differences were found with regard to years of practice (p=0.02, p=0.04); three were found related to years since graduation from university (p value ranging from 0.01 to 0.04). These results are not believed to be of practice significance. No differences were found in the ratings between 2-year and 3-year diploma graduates. Discussion and Conclusion: The differences between diploma and baccalaureate education within the context of the 4 required competencies were largely expressed through cognitive abilities including critical thinking, problem solving, and research use. Both the knowledge base and the practice judgements of respondents were expressed as being improved with degree education. The outcomes of this study highlight the importance of baccalaureate education in supporting evidence-based decision making by dental hygienists.

Background: The purpose of this study was to evaluate current computer literacy and information and communication technology knowledge, skills, and opinions of recent dental hygiene graduates from a dental hygiene program at an Ontario community college in relation to computer-aided learning (CAL) or web-based learning environments for continuing education. Methods: Questionnaires were sent by postal mail and email to 63 dental hygiene graduates. Participants could either return the paper format survey by pre-paid mail or complete the online survey questionnaire. Descriptive statistics were used to analyse the data. Results: A 40% (n=25) response rate was obtained. All respondents had access to a computer and the Internet at home or at work; most felt that Internet access at home and work was necessary. General computer skills were perceived as competent, except for accounting skills. Email use and Internet searches were the most frequent computer activities. Most respondents felt that CAL should be part of formal dental hygiene education and were receptive to the use of CAL for furthering their dental knowledge. Discussion: Although the respondents might have used their computers daily, this did not imply that they possessed the competency required for computer use in educational settings or the required skills to navigate different software. Some experience with webinars, online quizzes, and online courses during the dental hygiene entry-to-practice formal education might increase the confidence level of graduates to participate in web-based or online continuing professional development courses in the future. Conclusion: Strategies to assist dental hygiene educators and school administrators in planning or modifying current dental hygiene programs to better equip their graduates for lifelong computer-based professional development are recommended.

Oral cancer is a disease with a multifactorial etiology. While this disease may arise with no prior risk history, traditional risk factors have included smoking and alcohol consumption in a demographic population made up predominantly of males in the 5th to 7th decade of life and involving higher risk intraoral sites such as the floor of mouth, lower lip, and ventral and lateral surfaces of the tongue. However, there is an increasing amount of research linking a viral etiology to oral carcinogenesis and, in particular, the role of human papillomavirus (HPV) in the pathogenesis of this disease. HPV is now considered to be an independent risk factor for a subset of oral squamous cell carcinoma, namely, oropharyngeal squamous cell carcinoma. This subset is also defined by a younger demographic, involving primarily non-smokers and non-drinkers, and favours high-risk sites such as the base of tongue, soft palate, and the tonsillar region. This short communication will highlight the emerging evidence surrounding the role of HPV in oropharyngeal carcinoma.

**Objective**: This study investigated whether the Resident Assessment Instrument–Minimum Data Set (RAI–MDS) 2.0 is capable of predicting dental need in a sample of elderly long-term care (LTC) residents. The RAI–MDS is conducted by nursing staff and is designed to address LTC residents’ needs and to facilitate the development of care plans. Therefore, it is important to know if the dental and oral health components of this assessment provide accurate and valuable information. **Methods**: Chart reviews were conducted comparing RAI– MDS data with onsite dental assessments. Assessments collected from 2008–2012 on residents aged 65 years and older were used. **Results**: A total of 332 assessments were used for comparison in the study. Early data analysis reveals discrepancies in assessments conducted by nursing staff and the dental professional. The prevalence of moderate to severe gingivitis recorded by the dental professional was 74% compared to less than 1% prevalence of inflamed gums recorded by the nursing staff on the RAI–MDS. The RAI–MDS data showed negligible documentation of orofacial pain, and significant differences were found in recording the residents’ state of dentition. Although RAI–MDS data show that daily care is being performed, the oral health status of the population, determined by the comparative dental assessments, is still very poor. Individual dental RAI–MDS items that are expected to suggest treatment need, such as orofacial pain and caries, do not show any significant association with the dentist’s identification of treatment need. **Conclusion**: There is a need to elevate awareness of the oral health of older adults, especially those residing in LTC facilities who may be dependent on others for oral care provision and be susceptible to poorer oral health. The current use of the RAI–MDS does not appear to be useful in identifying individuals in need of dental treatment, indicating that a more effective assessment process is required. The results from the current study support the need to develop a sensitive oral health assessment tool, which can identify those individuals who require attention.

**Objective: **Ontario public health units conduct dental screenings of specific grades in elementary schools as mandated by the Ontario Public Health Standards (OPHS). However, this presents the challenge of how best to manage resources in order to meet these mandates. Recognizing that the OPHS directives for selecting the target populations for screenings do not adequately capture hidden high-risk populations, this project sought to capitalize on the dental hygienists’ experiences in the schools, in conjunction with local data, to maximize the impact of school screening in Peel. **Methods:** Three marginalization indices (Social Risk Index and two components of the Ontario Marginalization Index) were used to prepare maps to identify high-risk populations. The results were combined with oral health screening data and dental hygienists’ knowledge of the school populations. These data were used to determine which grades in each school would be screened in the 2012–2013 school year. **Results:** School screenings began in September 2012 with positive preliminary results, including increased numbers and rates of urgent cases. Final results will be available following the completion of the school year in June 2013. **Outcomes:** The project has demonstrated that a “one size fits all” approach makes it difficult to assess accurately the dental risk in schools with a diverse population. The project enabled us to target our resources to high-needs areas and better identify children in need of dental treatment.

**Background:** Worldwide, about 400,000 people will be diagnosed with oral squamous cell carcinoma (OSCC) and oropharyngeal squamous cell carcinoma (OPSCC), with a 50% mortality rate. Well-established risk factors for OSCC include tobacco use and alcohol consumption. However, recently there has been an increase in the incidence of cancers arising in the oropharynx and at the base of the tongue, especially among younger individuals, without the typical risk factors, such as tobacco and alcohol use. Human papillomavirus (HPV) infection has now been identified as an etiologic agent for OSCCs, especially for oropharyngeal and tonsillar cancers; HPV has been detected in 29% of OPSCC patients, and only 3.9% of OSCC cases. In our own study we detected HPV in 33.3% of OPSCC case patients. The increasing incidence of HPV-related OPSCCs is of considerable public health importance. To date, no study has used state-of-the-art approaches to search for novel HPVs in OPSCC now considered “HPV negative” OPSCC. **Objectives:** The aims of our study are as follows: 1) discover novel HPVs using high throughput sequencing technology in oral lavage samples collected from newly diagnosed and untreated OPSCC patients; 2) determine prevalence of novel HPVs in archived OPSCC tissue samples; and 3) determine frequency of novel oncogenic HPVs in cancerous and noncancerous oral lavage samples. **Expected results:** We hope to detect novel types of HPV, as we have already detected and sequenced three new types of HPV from noncancerous samples. The prevalence of the new HPVs is expected to be greater in OPSCC archived tissue samples and in much higher concentrations compared to controls. The novel HPVs will have a higher frequency in the cancerous oral lavage samples compared to the controls. **Expected conclusions:** Novel types of oncogenic HPVs do exist in OPSCC, which warrant further research to provide new information for detection, treatment, and prevention.

**Background:** Screening for oral cancer should be easy: the exam is fast, non-invasive and the site is easy to visualize, yet more than 60% of oral cancers are diagnosed late when the treatment is complex and prognosis is poor. Adjunctive screening devices (ASDs) such as toluidine blue (TB), fluorescence visualization (FV), chemiluminescence (CL), and brush biopsies have been designed to assess risk of oral lesions and aid in the identification and localization of oral premalignant and malignant lesions. **Objective:** To evaluate the use and level of comfort using ASDs for oral cancer screening among dental hygienists. **Method:** A stratified random sample of about 3000 dental hygienists from four Canadian provinces were contacted by email and provided with a link to an online survey that included questions related to the use and comfort level of using ASDs. **Results:** 369 hygienists completed the survey section on ASDs, 93 (25%) had used an ASD of some type. Use of ASDs was associated with 6 continuing education (CE) courses per year (P=0.030), having taken a recent CE course in oral pathology (P=0.003) and having an established screening protocol (P=0.008). FV was the most commonly used ASD and the one that dental hygienists felt most comfortable using. Very few dental hygienists used brush biopsies. Older graduates were more comfortable using TB (P=0.014) and CL (0.033) than newer graduates. **Conclusion:** Current evidence and education appear to help hygienists feel more comfortable using ASDs. ASDs with minimal research, and which have not been specifically targeted to dental hygienists, are not well utilized.

**Objectives:** The aim of this study is to investigate whether twice-daily use of a rotating–oscillating power toothbrush (Oral-B Professional Care 1000™) in nursing home residents will 1) increase caregiver compliance with oral care; 2) reduce oral inflammation; and 3) reduce systemic inflammation. **Methods:** In this repeated-measures, single-blind, randomized controlled trial begun in November 2012, sixty residents of a large nursing home in Winnipeg, Canada, were randomized to receive either twicedaily toothbrushing with a rotating–oscillating power toothbrush or standard care by caregivers. The study received institutional ethics approval, and consent was obtained from residents directly or from their proxies. Participants had the following characteristics: some natural teeth present, oral inflammation, non-aggressive behaviour, no communicable diseases, non-smokers, and non-comatose. Outcomes were recorded at baseline and 6 weeks and included measures of oral inflammation (MGI, Lobene); bleeding (PBI, Loesche); plaque (Turesky); systemic inflammation (hsC-reactive Protein); caregiver compliance (daily oral care chart); and an 11-item caregiver survey. Primary and secondary analyses of oral and systemic measures will employ the Kruskal-Wallis test while caregiver compliance will be analyzed with descriptive statistics. **Expected results:**Caregivers of nursing home residents will get better compliance with the use of power toothbrushes for twice-daily oral care delivery as compared to standard care. Twice-daily tooth brushing with a rotating–oscillating power toothbrush will result in significant reductions in plaque, oral, and systemic inflammation. **Expected conclusion:** Introduction of a rotating–oscillating power toothbrush for daily oral care in nursing homes will contribute to improved resident oral and systemic health.

**Background:** Dental hygiene students self-selected to take an advanced practicum in long-term care during the final year of a baccalaureate dental hygiene program. These settings are complex, with clients having a range of medical, physical, psychological, and cognitive conditions. With the growing older adult population who may end up in long-term care, it is critical to provide advanced learning opportunities for students to better prepare them for practice in such settings. **Purpose:** The purpose of this project was to examine the professional development and experiences of dental hygiene students to these settings. The experience is examined from both the student and clinical educator perspective. **Methods:** Student reflective journals and interview transcripts with students and registered dental hygienist (RDH) clinical educators were analyzed using a constant comparative analysis approach. One researcher reviewed the journals and transcripts to develop the initial set of thematic codes and their definitions. Together with a second researcher, the data were independently coded. Inter-rater reliability was calculated using Cohen’s Kappa. The two researchers met to compare analyses and achieve consensus. **Results:** Preliminary data analysis identified the following thematic codes: 1) increased student confidence and preparedness for practice; 2) increased ability to put into practice verbal and nonverbal communication techniques with older adults; 3) enriched understanding of establishing rapport with residents and staff; and 4) enhanced value and appreciation for applying educational theory to practice. **Conclusion:** The professional development of undergraduate dental hygiene students following varied experiences in long-term care settings requires repeated exposure to the population involving hands-on experiences with residents and staff coupled with supportive guidance from a dental hygiene clinical instructor.

**Background:** Oral cancer has a poor survival rate mainly due to late-stage diagnosis and high risk of developing of secondary oral cancers. Despite considerable improvements in treatment and intensive follow up, there is a need to identify clinicopathological risk factors and reliable molecular markers for monitoring patients after initial treatment. **Objectives:** To discover clinicopathological and molecular risk factors associated with the development of a second oral malignancy (SOM) in former oral cancer patients. **Methods:** Patients diagnosed with high-grade dysplasia (HGD) or squamous cell carcinoma (SCC) and treated with curative intent were recruited to the ongoing longitudinal BC Oral Health study. Data collected included 1) demographic and habit information; 2) primary tumour information; 3) allelic imbalance at 12 chromosomal regions; and 4) clinicopathological features within the oral cavity during follow up. **Results:** 309 patients with a HGD or SCC were treated with curative intent; 60 (19%) developed a premalignant lesion at a different site. Of these patients, 11 (18%) progressed to HGD or SCC. Clinical and molecular data are being analyzed. **Conclusion:** Determining reliable prognostic indicators will aid in the identification of patients who are at high risk for SOM development and enhance surveillance, targeted treatments, and chemoprevention. Ultimately translating this knowledge to the clinical management of patients will improve morbidity and long-term survival rates.

Letters to the Editor

Introduction: As the population ages, educational health care programs must increase efforts to provide geriatric health knowledge to students and to socialize them into settings such as long term care (LTC). Methods: A new practicum was developed in which dental hygiene (DH) students were scheduled onsite in LTC facilities. A guiding objective for the practicum was to socialize students into this environment by providing them with practical knowledge and experience that could give them the confidence, attitudes, and desire to work with this population upon graduation. This study provides a qualitative analysis of data acquired from focus groups with the students and from individual interviews with the registered dental hygienist (RDH) instructors who guided them. Results: Six main themes were identified from the student focus group data: 1) communication challenges between students and LTC staff; 2) communication challenges between students and LTC residents; 3) uncertainty about follow up for oral health recommendations; 4) barriers to provision of daily mouthcare; 5) uneasiness of students in LTC environment; and 6) appreciation for the practicum experience. Transcripts from the RDH interviews revealed two themes: 1) challenges in the facility context; and 2) challenges and enhancements for student learning. Discussion: From these results, we determined that changes need to be made to the practicum, including: providing more classroom preparation before the practicum; beginning the practicum earlier in the year to provide students with more experience; arranging onsite visits to correspond to the schedules of the residents and staff; improving and increasing interactions between students and LTC staff; and developing and establishing clear protocols for what students should do under specific conditions, and how their recommendations for residents can be implemented. Conclusion: We believe that the practicum successfully contributed to the socialization of DH students into the LTC environment by building their awareness of the complexities of working in this context with this population.

Objectives: The aims of this study were twofold: 1) to evaluate the prevalence and severity of traumatic gingival recessions (GR) in a sample of dental students; and 2) to assess the influence of oral hygiene related factors in the development of such lesions. Material and Methods: From the initial sample of 250 dental students enrolled, 80 fulfilled the inclusion criteria. One calibrated examiner interviewed all students using a written questionnaire. The same examiner then assessed the presence of buccal GR. Logistic regression analysis was performed to investigate the association between GR, hygiene habits and deterioration of toothbrush bristles. Results: Overall, the prevalence of GR was 86.25 per cent, and the average rate of GR per patient was 4.05. Only the independent variable—deteriorated toothbrush bristles, p=0.02—was found to correlate with the occurrence of GR, with odds ratio of 2.77 and 95% confidence interval of 1.15–6.70. Conclusion: The development of GR was associated with deterioration of toothbrush bristles. Further investigation, focusing on the effect of traumatic toothbrushing, is required.

Nearly 200,000 Canadians live in long term care (LTC); many are more than sixty-five years of age, frail, and dependent on others for their daily care. With the growing trend of older adults successfully retaining more of their own teeth longer in life, their need for assistance with daily oral care and access to onsite preventive dental hygiene care is significantly different than in any previous generation. Yet, oral healthcare is widely recognized as inadequate in care facilities, resulting in widespread oral disease, and challenges to residents’ overall health and quality of life. This article identifies dental hygienists as ideally suited to champion and sustain oral healthcare change in LTC. A multi targeted, multi strategy approach that extends beyond the focus of clinical care is proposed, along with strategies and tips for carrying it through. This proposed approach is based on dental hygienists’ years of experience in caregiver engagement, education and training, resource development, and interprofessional collaboration within the LTC environment, and is modelled on the ADPIE format.

Background: Aspiration pneumonia (AP) is a serious risk for dependent adults in long term care (LTC), especially for those with swallowing dysfunction. Hypothesis: To test whether a suction toothbrush reduces the incidence of aspiration pneumonia in dependent adults with dysphagia. Methods: This pilot examiner blind parallel group randomized control trial invited all dysphagic residents from one LTC facility to participate (protocol ref. #H2007:051). Caregivers were trained in mouth care using a suction toothbrush. Twenty-two participants were examined at baseline, received scaling and root planing (SRP), and were randomly assigned to equally sized suction or manual toothbrush groups. Participants then received twice daily mouth care for one year from trained caregivers. Oral health parameters were reassessed after one month, and pneumonia outcomes were monitored for one year. Results: The 22 consenting participants averaged 54.3 years of age and included 12 females (54.5%). The following changes between baseline and 1 month examination were statistically significant (p<0.05): plaque index 2.9 to 1.0; calculus index 1.1 to 0.2; pocket bleeding index 5.9 to 1.7; gingival index 1.7 to 0.9; and probing depth 3.3 mm to 2.6 mm. Of the 19 participants available at 1 year, six (31.6%) had experienced a total of 62 days with pneumonia with a mean of 3.3 days per subject. Study participants showed significantly lower pneumonia rates than did the general long term care population (1.2 versus 3.4 pneumonia days per 1,000 patient days) although no additional benefit was obtained with the suction toothbrush compared to the manual toothbrush. Conclusion: This study showed that SRP and daily mouth care improves oral health and reduces pneumonia rates in adults with dysphagia. The suction toothbrush produced results equivalent to those achieved with a manual toothbrush.

Introduction: Significant improvements have occurred in the overall oral health status of the Canadian community population; however, oral health in residential care continues to be a long standing problem. Despite the importance of preventing oral diseases and of maintaining a person’s psychosocial wellbeing, daily oral hygiene is recognized as a low priority for staff, administration and government inspectors. Purpose: The purpose of this paper was two fold: To present findings based on factors associated with daily oral hygiene in residential care homes in Ontario, and to discuss solutions based on current legislation in residential care. Methods: Data collected on 17,848 older persons in Ontario during ideas for Health projects used the Minimum Data Set (2.0), and identified the characteristics associated with having daily oral hygiene performed by staff or resident. Results: Approximately 2 per cent of residents were not receiving any daily oral care of teeth or dentures. Older persons with higher scores on the Activities in Daily Living (ADL) scale (p=0.03) and persons who were more care dependent (p<0.0001) were significantly more likely to receive daily oral care. Conclusions: While daily oral care is being provided to older persons with higher care needs, frail older persons in residential care with lower scores on the ADL scale are less likely to have daily oral care. This paper supports further educational and regulatory initiatives—including the integration of gerontology and geriatrics in the dental sector—as a solution to provide oral care to this segment of the Canadian population.

Objective: To evaluate the literature regarding the effectiveness of autologous platelet rich fibrin (PRF) in the treatment of periodontal intrabony defects (IBD). Method: A detailed search was conducted through the electronic databases of PubMed, CINAHL, Google Scholar, and the Cochrane Central Register of Controlled Trials (CENTRAL); and five in vivo human peer reviewed trials addressing the effectiveness of PRF in periodontal IBD were included. Results and Discussion: Statistically significant results showed in: 1) all five studies in clinical and radiographic periodontal parameters with the use of PRF in open flap debridement (OFD) as compared to OFD alone; 2) three of the studies in probing depth (PD), and 3) four out of the five studies in clinical attachment loss (CAL). All studies presented statistically significant differences for IBD fill, as measured on standardized radiographs read by computer aided software. Conclusion: The potential clinical implications for this inexpensive and autologous material are promising. Further long term, larger, multicentred randomized controlled clinical trials are required to determine the effects of PRF on the regeneration of alveolar bone due to periodontal disease.

Objective: To evaluate whether full mouth ultrasonic debridement (FMUD) can eradicate Helicobacter pylori (H. pylori) from the oral cavity of patients with gingivitis and periodontitis after systemic eradication therapy (STT). Methods: Nine patients— six with gingivitis and three with chronic periodontitis—testing positive for H. pylori in the oral cavity after systemic triple therapy were evaluated. Microbiologic samples of DNA from six patients with gingivitis and three with periodontitis presenting H. pylori in the oral cavity after STT were evaluated by PCR, before and three months after FMUD. Results: Three months after treatment, H. pylori was eradicated from the oral cavity of five patients with gingivitis (83.3% of the gingivitis group). The DNA of H. pylori could not be recovered from saliva, the dorsum of the tongue or supragingival plaque of all patients. However, four patients (three with periodontitis and one with gingivitis) were still positive for H. pylori in the mouth (i.e. subgingival plaque) and two of them (one of each group) tested positive again in the stomach. H. pylori was still detected at the subgingival plaque of all patients with periodontitis and one with gingivitis. Conclusion: Within the limits of this case series, a single session of oral hygiene instruction combined with FMUD seemed to promote a positive effect in eradicating H. pylori solely from supragingival sites

"Dental hygiene continues to evolvei as a profession, and implicit in this evolution is the continuing development of the Canadian Journal of Dental Hygiene (CJDH), the Canadian Dental Hygienists Association's (CDHA) professional publication that was first published in 1967 under the title, Canadian Dental Hygienists Association Journal" Cobban SJ and Dempster LJ Peer review as professional development Can J Denr Hygiene: 2010:44(3):107

Background and purpose: Dental hygienists have been targeted for practice expansion to improve public access to oral healthcare, specifically by changing their scopes of practice and healthcare delivery models. Dental hygienists must demonstrate their decision making capacity within existing and new frameworks to support such an expansion. This paper presents the Phase I findings of a mixed methods study. The aim was to explore dental hygiene decision making, identify key influences on decision making and develop a qualitative dental hygiene decision making model based on those influences tested in Phase II. Organizational and feminist theories underpinned the study. Methods: A phased mixed methods research approach was used. Phase I involved a series of focus groups interviews. Collected narrative data underwent qualitative thematic analysis to identify key themes believed to influence decision making capacity. These themes served to inform the development of a qualitative dental hygiene decision making model. Results: Qualitative analysis of focus group data yielded over 75 codes, and six themes emerged as being influential in dental hygiene decision making capacity. Of these themes, five reflected organizational constructs whereas one was shown to be individualistic. An additional organizational theme arose from the literature. A qualitative dental hygiene decision making model was developed using these interrelated key themes along with environmental features. Conclusions: While most of the key themes influencing dental hygiene decision making capacity were found to be organizational, one was individualistic and more aligned with previous research. It was concluded that both the organizational structure and one’s individual agency influenced dental hygiene decision making capacity.

Objective: Early childhood caries (ECC) and iron deficiency (ID) are conditions of early childhood that affect an alarming number of Canadian children. This study was part of a larger investigation of dietary patterns and micronutrient status in young children of low income families in Vancouver, Canada. Our part of the study investigated risk factors for caries in these children to determine which factors were also associated with iron deficiency. Methods: Parents and children were recruited at community locations in Vancouver. Data collection—a two stage process—included sociodemographic, dietary and oral health questionnaires; a dental assessment; and hematological, biochemical and anthropometric measurements. Results: Of the 96 children who completed the study, 64.6% had dental caries and 25.0% were iron deficient. For 38.5% of the children, weight for age, height for age, and weight for stature were above the 75th percentile. Multivariate analysis demonstrated a significant relationship between dental caries and age and food security (p<0.005). Caries was significantly more prevalent in older children but ID was found primarily in the younger children. From the bivariate analysis of data for children under 36 months, ID was related to daily consumption of more than 3 cups of milk, (p<0.05). Conclusion: No risk indicators common to both ECC and ID were identified in this group of multi ethnic, inner city Vancouver children of low income families. Daily milk consumption was associated with ID in younger children. Food security, an issue related to poverty, demonstrated an association with caries in older children that warrants further study.

Observation: Research has demonstrated that oral care provided by nursing staff is often “inadequate or non existent”, and points to the need for training in specific oral care strategies. This study explored the impact of an oral hygiene education program for unregulated care providers, and examined the nurses’ perception of their role in directing the oral care practices of the unregulated care providers. Methods: An intervention study was performed by a dental hygienist and a nurse educator on the neuromuscular unit of the hospital. It was implemented by using pre- and post questionnaires, education sessions and evaluations. An oral care audit was completed by the Toronto Public Health Dental Unit. Discussion: It was determined that nurses had a strong belief in looking after their own oral health and that of their patients, yet some nurses were unsure of their accountability. Some of the unregulated care providers demonstrated that they were not comfortable with providing certain aspects of mouth care and providing mouth care to patients who had behavioural issues. Role clarification in oral care practice for both groups was addressed during the sessions. They felt that the knowledge learned gave them confidence. Conclusion: The study demonstrated that there was a change in the approach to oral care practices of the nurses and the unregulated care providers. They worked as a team to provide proper mouth care to their compromised patients

Objective: Halitosis is a common occurrence. Halitosis of non oral origin (extra oral) occurs in about 10% of cases, often going undetected, and possibly resulting in serious medical consequences. This review aims to identify and classify the etiologies of extra oral halitosis, describe assessment and differential diagnosis techniques and provide treatment and management strategies. It also highlights the importance of multidisciplinary treatment to reduce prevalence of this condition and to improve overall health. Methods: The search strategy was limited to articles published in English between 2008 and 2012. Searched databases included: MEDLINE, CINAHL and Scopus. MeSH subheadings and a combination of keywords were used in all three databases. To further verify references, Scopus was searched again, using exact search terms and time period for articles that had cited works published prior to 2008. This citational cross referencing method helped extract names of renowned authors on extra oral halitosis. The mined articles consisted principally of reviews and each was systematically evaluated for inclusion. Results: Halitosis impacts over 60% of individuals worldwide and may restrain social interaction and negatively impact self image. Volatile sulfur compounds are the malodorous source of both types of halitosis. Extra oral halitosis is blood borne and non blood borne, providing critical clues to the origins of cause. Treating extra oral halitosis necessitates locating the source, obtaining a differential diagnosis and eliminating the cause. Conclusion: Patients look to oral care providers for resolution. Diagnosis requires trained and calibrated breath assessors and/or gas chromatography. Remediation requires multidisciplinary collaboration; the etiology of extra oral halitosis is generally metabolic or systemic.

The concept of evidence based practice is one that is now well known and applied frequently in oral healthcare. Research in the science based professions has predominantly employed quantitative methods, fuelled by this drive towards evidence based practice in recent decades. Although now used with increasing frequency in dental hygiene, relatively few studies are conducted using qualitative methods. Consequently, familiarity with qualitative research, including its purpose, various approaches and appraisal is limited. This paper therefore attempts to “decode” the qualitative research process and aims to strengthen the readership’s understanding of qualitative methodology by providing an introductory description and analysis of its purpose, approaches, and strategies for rigour while contextualizing its value in dental hygiene.

Objective: Xerostomia—whether a result of treatment for head and neck cancer, or disease states such Sjögren’s, or side effects of medication—has a devastating impact on quality of life. Thus, it is imperative that health professionals who work with patients afflicted by xerostomia understand the most current interventions, both preventive and therapeutic. Method: A Medline search was undertaken to understand advances in this field. Forty-five journal articles, which reported on recent advances in the prevention and treatment of xerostomia, were reviewed in the literature from January 2008 to July 2011. Results: Interventions, described in the literature during this period, included surgery, pharmaceuticals, advanced radiotherapy, salivary substitutes, acupuncture, electrostimulation, and hyperbaric oxygen therapy. In preventing xerostomia, surgical and advanced radiation systems appear to be most promising. In treating xerostomia, the results suggest that many of the interventions promote salivary flow; however, this does not always result in a change in the patient’s perception of dry mouth. Conclusion: While some of these interventions hold more promise than others, regenerative medicine techniques are currently being applied in animal studies, and may be an important future consideration in the battle against xerostomia.

Objective: The American Dental Association Council on Scientific Affairs selected an expert panel to review the science regarding efficacy for non fluoride anticaries products and to assist practitioners with decisions on the use of non fluoride caries preventive agents to arrest, prevent or reverse caries. The purpose of this paper is to review and summarize the most important aspects of the panel’s report. Methods: The expert panel conducted a systematic review of the literature to answer the following clinical questions: 1. In the general population, does the use of a non fluoride caries preventive agent reduce the incidence, arrest or reverse caries? 2. In individuals at higher caries risk, does the use of a non fluoride caries preventive agent reduce incidence, arrest or reverse caries? Findings: The majority of non fluoride agents— xylitol, chlorhexidine, amorphous calcium or casein derivatives, etc.—have weak evidence as anticaries agents and most were not recommended for use. Those recommended were to be used as adjuncts in individuals at high risk of developing caries. Conclusion: Only one product, chlorhexidine/thymol varnish, received a recommendation for reducing root caries. One product was graded as having weak evidence for implementation—sucrose free polyol– xylitol only or polyol combinations chewing gum—for coronal caries reduction. The panel strongly recommended that practitioners first implement evidence based anticaries products or practices —fluoride, sealants, dietary practices limiting sugar consumption— before attempting to use non fluoride adjunctive therapies.

Background: The oral health of prison populations in several countries has been shown to be compromised. However, little published research on Canadian prison populations is available. The purpose of this research paper is to determine whether such populations in Canada also suffer from compromised oral health. Methods: A convenience sample of forty-one formerly incarcerated individuals participated in the study in three New Brunswick urban centres. The study consisted of a questionnaire administered as a structured interview. Results: Reported risk factors included tobacco use (74% of respondents), type 2 diabetes (13%), drug or alcohol dependency (38%), and consumption of cariogenic foods and beverages (100%). One hundred per cent of the sample reported access to toothbrushes and dentifrice, while 42 per cent reported access to dental floss or floss picks. Seventy-six per cent reported toothbrushing frequency = twice daily; 68 per cent reported “never” flossing. Fifty-four per cent reported having had dental treatment while incarcerated. The majority of the respondents (85%) expressed interest in a complimentary dental cleaning. Discussion: The findings were consistent with the results of studies from Australia and the UK. Dental hygienists may help prisoners meet their specific oral health needs, once these are properly identified through appropriate research such as clinical studies. Conclusion: Although the sample size of this study was limited, its findings imply that Canadian prison populations are likely to present with high oral health needs due to multiple risk factors. Correctional facilities may provide a novel environment for initiatives to improve oral hygiene self care modalities. Future clinical studies and surveys involving larger, multicentre samples of prison populations are indicated to assess accurately specific prisoner needs.

Objective: Although scaling and root planing (SRP) with manual and ultrasonic scalers is the traditional approach for non surgical periodontal therapy, limitations related to difficulty in accessing furcations, grooves, and deep pockets have led to the exploration of other therapeutic modalities. The aim of this review was to investigate whether the Er:YAG laser is more efficacious than conventional SRP in the treatment of chronic periodontitis. Method: Electronic database searches of EBSCOhost, PubMed, and the Cochrane Central Register of Controlled Trials (CENTRAL) were performed, identifying articles from 2000 through to end of search on June 30, 2011. A total of 61 papers were identified, of which six met review criteria. Results: Five randomized controlled clinical trials and one meta analysis were retrieved. Results for periodontal pocket depth reduction and clinical attachment level gain varied in significant difference between the two treatment groups. Only one study found significant differences between the two modalities of treatments of gingival recession and bleeding on probing, while none of the studies found a significant difference among treatment modalities for plaque and gingival index level changes. Microbiological analysis of subgingival plaque indicated significant differences with specific bacteria; however, each study used a different method of analysis, which made comparison difficult. Conclusion: The available data indicate that both the Er:YAG laser and conventional SRP are effective for periodontal therapy; yet the data were inconclusive in demonstrating that the Er:YAG laser is more efficacious than conventional SRP.

Objective: The purpose of this review was to examine existing literature for evidence supporting the bidirectional relationship between diabetes mellitus (DM) and periodontal disease. Method: A search research related to DM and periodontal disease was conducted through PubMed, CINAHL and CCRCT. Search terms included: periodontal disease, periodontitis, diabetes mellitus, glycemic control, hemoglobin A1c, glycated hemoglobin, and HbA1c. The search was limited to randomized controlled trials, meta analyses and systematic reviews (SR). Results and Discussion: Literature suggests those with Type 2 DM (T2DM) appear to have a 2.6 to 4 times greater risk for more severe periodontal disease than those without DM. Meta analyses also report statistically significant differences in clinical attachment level (CAL) from ˜0.612 to 1 mm for persons with T2DM compared to those without diabetes. The mean difference in hemoglobin A1c (HbA1c) in the literature following periodontal treatment appears to be approximately -0.40%. Major limitations to the existing research is failure to control for confounding factors impacting HbA1c. Conclusion: Despite the potential impact of confounding factors on research findings, it seems clear periodontal disease is more severe in those with diabetes, and that there are small, statistically significant improvements in gylcemic control with non surgical periodontal therapy (NSPT). Dental professionals need to advise individuals with DM to prevent and manage inflammation in the oral cavity to promote overall health. Well controlled research on the bidirectional relationship is essential to identify unequivocally the factors linking these conditions.

Objective: The purpose of this systematic review (SR) was to answer the focused research question: Is there an association between periodontal disease and pneumonia or chronic obstructive pulmonary disease (COPD)? Method: Databases and keywords searched included: Medline, PubMed, and the Cochrane Database of Systematic Reviews on combinations of lung disease, obstructive pneumonia, and periodontal disease. The literature searches were limited to 1997 to 2011; humans; and in English. Inclusion criteria were RCTs/clinical trials, SRs/meta analysis, and longitudinal, cohort, case control, multicenter and epidemiological studies for links between COPD or pneumonia and periodontal disease. Results and Discussion: 114 articles from databases, and 22 from hand searching were scrutinized for predetermined inclusion and exclusion criteria. Of these, 17 and 4 (n=21) respectively met the criteria, were analyzed and scored independently by each reviewer to extract evidence: 1) seven well designed studies and 3 systematic reviews provided fair evidence of an association between periodontal disease and pneumonia; 2) two small scale studies, at lower levels of quality of evidence, indicated conflicting results; 3) five well designed longitudinal or matched case control studies provided fair evidence of an association between periodontal disease and COPD; 4) four large scale, retrospective studies also supported this association. Conclusion: A causal association between respiratory diseases (pneumonia or COPD) and periodontal diseases remains conjectural. The conclusions reached based on this SR indicate there is fair evidence—Grade B, Level II-2—supporting: 1) an association of pneumonia and periodontal disease concurring with previous reviews; 2) an association between COPD and periodontal disease.

Objective: There has been an increasing interest in exploring the link between oral and systemic health. As periodontal disease is a chronic inflammatory process, it has been associated with other conditions such as arthritis, obesity, kidney disease, and Alzheimer’s disease where inflammation plays a significant role. This article examines the current state of evidence that links periodontal health to the systemic conditions of arthritis, obesity, kidney disease and Alzheimer’s disease. Methods: The PubMed and CINAHL databases were searched using periodontal disease and the respective inflammatory diseases as keywords. Discussion: While the literature supports the assertion that periodontal disease is associated with systemic inflammatory conditions such as arthritis, obesity, kidney disease and Alzheimer’s disease, the correlative nature of the studies do not allow for determination of causation. Conclusion: Additional studies, both at the basic science and clinical level are necessary to elucidate fully the association between oral and systemic health.

Objective: The purpose of this narrative review is to examine evidence in research of chronic periodontal inflammation and cerebrovascular disease (stroke) and to identify biologic plausibility, strength of evidence and results of the best evidence. Methods: A search for systematic reviews (SR) related to stroke and periodontal disease (PD) was conducted through Pub Med using MeSH terms of stroke, cardiovascular disease, periodontal disease, oral–systemic relationship. Recent high level evidence not included in SR was examined for additional evidence. Results and Discussion: There are few SRs and primary studies investigating the topic but epidemiologic studies reveal a moderate association between PD and stroke. However, several studies do not show associations. Specificity is not established for any associations as there are multiple risk factors for atherosclerotic disease. Atheroma in carotid arteries was found to be significantly associated with oral disease burden and radiographic evidence of PD. Conclusion: A direct causal relationship between PD and atherosclerotic cerebrovascular disease has not been established and no prospective RCTs are available to evaluate reduced vascular events of intervention trials. Given the significant cost for an adequately powered RCT and the modest strength of epidemiologic evidence, rigorous trials to establish if causality exists between PD and stroke are unlikely.

Objective: The objective of the review was to summarize and critically evaluate the available evidence, using systematic reviews and meta analyses, concerning the statistical strength and the nature (statistical and/or causal) of the association between periodontal and cardiovascular diseases. Methods: The statistical association between periodontal and cardiovascular diseases was assessed after searching PubMed and The Cochrane Library (CENTRAL) databases for systematic reviews and meta analyses, published in English up to and including August 2011. The hypothesis stating a causal association between periodontal and cardiovascular diseases was examined using Bradford Hill’s criteria for causation. Results and Discussion: An independent statistically significant association of weak to moderate strength was found between periodontal and cardiovascular diseases, after adjusting for potential confounding factors, such as advancing age, gender, race, smoking, hypertension, diabetes, indicators of socioeconomic status, stress, obesity, and lipid rich diet. The present analysis demonstrated only a partial fulfillment of Bradford Hill’s criteria for causation. Conclusions: Periodontal diseases have an independent statistically significant association with cardiovascular diseases, although weak to moderate, after adjusting for the above mentioned potential confounding factors. It still remains unclear whether periodontal diseases are causal for cardiovascular diseases. Clinicians should inform patients about the association between periodontal and cardiovascular diseases, but should not overestimate or exaggerate the strength of this relationship.

Purpose: To determine uniform related infection control practices of a group of dental hygiene students, and to compare the results with existing literature related to cross contamination via uniforms in the dental field. Method: Online databases, Medline / PubMed, and Google Scholar were searched for papers in peer reviewed journals published on microbial contamination of uniforms in the dental environment. The search resulted in only seven published articles relevant to the topic; six studies and one review. A questionnaire was distributed to students at a Toronto post secondary dental hygiene program, which queried the students’ methods and frequency of laundering and sanitizing their uniforms and name tags. It also queried their willingness to use disposable uniforms as an alternative. Results: The students’ study revealed a lack of attention to the necessity of frequent laundering (19% washed twice a week or more), washing separately (55% washed separately), and of sanitizing name tags (21% disinfected name tags). Conclusion: There is an important requirement for raised awareness, standards, protocols and training in the dental environment to minimize the potential for the spread of infection. Further research is recommended in laundering and sanitizing procedures. Schools and hospitals could consider providing disposable uniforms where applicable.

Background: Caffeine is one of the most commonly consumed ingredients in the world. It has been an additive in analgesics for years, but its role as an analgesic adjuvant is unclear. Optimal pain management with safe and effective analgesia is crucial in the dental field, and if caffeine is an effective analgesic adjuvant, this cost effective drug combination can be considered in clinical practice. Objective: To identify the literature on the effect of caffeine as an adjuvant to OTC analgesics for postoperative dental pain. Method: A scoping review method was used: 1) identifying the research question 2) searching for relevant studies; 3) study selection; 4) data extraction; and 5) collating, summarizing and reporting the results. Results: A total of ten studies were included from CINAHL, Medline, PubMed and Embase. Clinical trials demonstrated an increased efficacy of analgesic effects and results from the meta analyses and systematic reviews were weakly positive or inconclusive. Contradictory results may be due to the dose dependent response of caffeine, the concentration–response curve theory, different pain types and intensities, and the different pharmacological effects of the co-drug. Conclusion: The effect of caffeine as an adjuvant to acetaminophen, ibuprofen, and aspirin for postoperative dental pain remains unclear. However, there is some evidence that caffeine enhances the analgesic effects under certain conditions. Further research is needed to determine the appropriate effective dose ratio of the caffeine–analgesic combination for each analgesic and for each pain source and intensity.

Background: Daily oral biofilm disruption by clients is recommended by oral health professionals to prevent oral diseases and to maintain optimal oral and overall health. Since periodontal diseases and caries are prevalent interproximally, the adjunctive use of interdental aids is highly recommended. Objectives: To evaluate the effectiveness of interdental brushing as an adjunct to toothbrushing for the primary outcome of interproximal gingival bleeding and a secondary outcome of interproximal plaque. Methods: Only randomized controlled trials were included. Studies were included irrespective of publication status and language. Hand searching was conducted in two peer reviewed journals, with references mined. Pharmaceutical companies that develop and manufacture interdental brushes were also contacted for unpublished or ongoing clinical trials. Sixty-two studies were retrieved from the literature with seven studies meeting the inclusion/ exclusion criteria. Forest plots and Chi-square tests were used to determine the presence of heterogeneity. Random effects model, relative risk and 95% confidence intervals were used in the analysis. Results: Four studies were included in the meta analysis for bleeding outcome. Although some heterogeneity was present among the studies, the interdental brush groups demonstrated statistical significance for reducing interproximal bleeding compared to the dental floss groups, p = 0.003. Plaque outcomes were analyzed using seven studies, with interdental brush demonstrating statistically significant differences to dental floss, p = 0.024. Conclusion: Interdental brush is an effective alternative to dental floss for reducing interproximal bleeding and plaque in clients with filled or open embrasures

Elderly people living in long term care facilities are at an increased risk of developing coronal and root caries due to limited mobility, side effects of medications, denture wearing and other factors. Fluoride varnish may be effective in preventing and arresting coronal and root caries in this population. Objective: The purpose of this paper is to examine the literature on the use of fluoride varnish in elderly people living in long term care facilities. Methods: Six key electronic databases were searched (Medline, EMBASE, CINAHL, Cochrane, BioMed Central and health-evidence.ca), and the titles and abstracts were screened. Those that met inclusion criteria were retrieved and key findings were extracted. Results: Seven hundred and ninety-nine citations were identified, and 10 papers, six clinical trials, and four systematic reviews met the inclusion criteria for the review. Data regarding effectiveness of fluoride varnish applications were extracted into tables. The application of fluoride varnish in elderly people living in long term care facilities who receive regular professional prophylaxis has demonstrated effectiveness in controlling coronal and root caries; however, it is less efficient in those with poor oral hygiene. Conclusion: Further research needs to be focused on ways of improving the oral hygiene of elderly in long term care facilities so that fluoride varnish can be effective in the reduction of coronal and root caries. Collaboration between long term care facilities and oral health professionals is necessary to achieve maximum benefit from fluoride varnish and for improved oral health of residents.

ABSTRACT Introduction: Although tonsillolith derived halitosis may affect a significant number of individuals, little attention has been given to increase the awareness of this condition to oral healthcare providers. Because these are the professionals who are primarily consulted by clients suffering from halitosis, it is crucial that such individuals possess knowledge of what the current literature provides concerning tonsilloliths and its relationship to halitosis. Methods: A literature review was performed to analyze the link between tonsilloliths and halitosis, as well as to investigate if any efforts had yet been done to increase this awareness to oral healthcare providers. A total of six papers were found which supported this link and were retrieved from CINAHL and PubMed databases. Results: Tonsilloliths not only emit a foul odour, but also contain obligate anaerobic bacteria that can produce volatile sulfur compounds associated with halitosis. Seventy five per cent of people who had tonsilloliths presented with abnormal halitometry, whereas only 6% of people presented with normal halitometry. Dycotomic logistic regression indicated that the presence of a tonsillolith represents a tenfold risk factor for halitosis, and case reports confirmed that the absence of halitosis was achieved upon tonsillolith removal and/or tonsillectomies. Conclusion: No papers addressed the need to increase the awareness of tonsillolith derived halitosis to oral healthcare providers. A proposal to implement this concept in the curriculum of dental educational institutions as well as to develop continuing education courses for oral healthcare providers addressing this condition is suggested.

Objective: This literature review is intended to provide an overview of obstructive sleep apnea (OSA) to assist dental hygienists with developing an OSA screening protocol. This paper will also provide a review of legal and ethical considerations related to the diagnosis, treatment, referrals, and the circle of care for OSA clients. Methods: OSA is associated with concomitant conditions such as obesity, hypertension, and cardiovascular disease and thus requires a multidisciplinary client management strategy. A multidisciplinary search was conducted using databases that include: Academic Search Premier, Bioline International, Biological Sciences@ Scholars Portal, Biomed Central, Medline, PubMed Central, Scifinder, Scholars Portal and Scholars Portal E-Journals. In addition, physicians, dentists, and an oral myofunctional therapist provided clinical perspectives. Discussion: OSA is a potentially fatal disorder that affects 15–24% of the adult population; however 70–80% of cases are undiagnosed. Clinical signs and symptoms include loud snoring, witnessed apneas, and excessive daytime sleepiness. OSA has a myriad of cardiovascular, metabolic and neurocognitive consequences. Untreated OSA may lead to cognitive impairment, sexual dysfunction, and a poorer quality of life. Many of the comorbid conditions and risk factors associated with OSA can be identified through a comprehensive dental hygiene client assessment. Conclusions: OSA can have serious detrimental effects on client’s overall health and quality of life. Dental hygienists are primary healthcare providers who can screen clients for OSA through comprehensive health histories and extra/intra oral assessments. Dental hygienists can facilitate a medical diagnosis by recognizing OSA signs, symptoms and risk factors, using OSA screening tools, and by providing the client with medical referrals. The dental hygienist may support clients with OSA by providing oral health education, and nutritional counselling.

Objective: The purpose of the article is to promote discourse among Canadian registered dental hygienists and educators about reporting suspicions of child abuse and neglect by presenting a study that was conducted in a US dental hygiene program in 1994 and 2009. Methodology: Survey data were collected on two classes of dental hygiene students from the same university based dental hygiene program. Results: Both groups of dental hygiene students were deficient in legal knowledge for reporting child abuse and neglect. Current students felt more prepared to recognize child abuse and neglect. Willingness to report scenarios of abuse and neglect were similar for both groups. Conclusions: Canadian registered dental hygienists and educators must be familiar with reporting laws in their territory or province. Survey of students’ knowledge and willingness to report may be a way to determine educational needs and outcomes.

Background: Dental anxiety is the most common psychological condition encountered in dental practice, yet gaps exist in our understanding of its epidemiology and psychology. The aim of this research was to develop a measure of dental anxiety suitable for clinical practice, and to investigate its reliability and validity in assessing cognitive and behavioural dimensions of dental anxiety. Methods: Reliability testing sampled clients presenting for treatment at the University of Toronto Dental Clinic who answered the Dental Fear and Avoidance Scale (DFAS ) on two separate occasions (n=41). DFAS validity was tested using a random sample of adults from Etobicoke, Ontario (n=1184) by comparing DFAS fear and avoidance scores with the Dental Anxiety Scale (DAS) and with responses to fear- and avoidance-related questions in a self report questionnaire. Results: Test–retest reliability of the DFAS reported a 0.87 intraclass correlation for both fear and avoidance. Significant differences (p< 0.01) were noted between: mean scores for low and high DFAS fear categories and questions regarding treatment; having a needle in the mouth and various evoking stimuli; and between low and high avoidance DFAS categories and questions about avoidance behaviours, frequency of clinical visits, and when subjects last saw a dentist or dental hygienist. A correlation of 0.60 confirmed fear and avoidance as related but distinct entities. A significant difference (p< 0.01) was also noted between DAS mean/standard deviation scores for subjects in low and high DFAS fear and avoidance groups. Kappa analysis reported a 0.43 level of agreement between both DAS/DFAS fear and DAS/DFAS avoidance. Greater agreement was also noted between the DAS and DFAS in identifying subjects with no dental anxiety than those with dental anxiety. Conclusions: The DFAS is a reliable valid measure of cognitive and behavioural dimensions of dental anxiety, and its simplicity makes it applicable for use in clinical practice.

Introduction: The goal of this literature review was to investigate current literature related to oral healthcare for individuals with auditory sensory impairments. Methods: A systematic search was completed on EBSCOhost, CINAHL with full text, MEDLINE with full text, and PubMed. The following search terms were used: auditory sensory impairment and dental care, hearing impairment and dental hygiene treatment, hearing impairment and dental care, hearing loss and dental care, hearing loss and oral health, hearing aids and ultrasonic scalers, and ultrasonic scalers. Selection criteria for the literature review included articles that: discussed original research or a literature review; were written in English and dated 1995 or later; and were accessible in full text through the databases or the UBC Library. Articles were also hand searched to eliminate irrelevant articles. Bibliographies of the selected articles were also scanned for relevant articles to include in the literature review. Additional resources were utilized to assist with background knowledge. Discussion: This literature review has exposed some gaps in the literature. Ample literature on meeting the needs of clients who are medically compromised was found. However, there is a lack of research that applies directly to auditory impairments and oral healthcare. Conclusion: This paper explores the specific needs of individuals with auditory sensory impairments and discusses the impact that this condition has on their oral health.

Background: Orthodontic therapy not only provides oral benefits to the client physiologically but it also contributes to an improved self confidence. However, compliance to conventional treatment is limited due to complications before, during, and after therapy. The development of Invisalign™ provides an option for clients to minimize possible challenges experienced throughout the process. Methods: A literature review was performed to provide information regarding the outcomes of orthodontic treatment. An electronic survey was conducted by dental hygiene students of Regency Dental Hygiene Academy Inc. to support the findings from the literature review. Results and Discussion: 61% of students responded. 87% of these students were satisfied with results and 81% indicated an improvement in self confidence upon the completion of treatment. 50% indicated that they were self conscious about their looks during treatment. Conclusion: Evaluation of the findings proved there was a consistency in an overall improvement in one’s self confidence after orthodontic treatment. The availability of Invisalign™ provides an additional benefit during the treatment process because it is aesthetically more pleasing compared to other orthodontic appliances.

2011; 45, no.3: 165–178 165 Short papers – CDHA national conference proceedings An early intervention strategy to improve the oral health of young children Karl Gunderson, RDH Interior Health Authority, Public Health, British Columbia karl.gunderson@interiorhealth.ca Background Interior Health’s Dental Program in British Columbia promotes the healthy growth and development of children’s teeth. As with any public health dental program, its success lies with using strategies which are constantly evaluated and adapted in relation to the needs of the population we service. Strategy Interior Health (IH) has employed, among others, an early intervention strategy to improve the oral health of young children. This strategy aims to educate the parents of infants on best practices in oral health. With a strong knowledge foundation, it is hoped that in the long run, overall oral health of the population will improve. This strategy was chosen based on the need for prevention of early childhood tooth decay (ECTD), as dental decay is the most common chronic disease of childhood. While private dental clinics have been and will continue to be the primary source of oral health care in Canada, the Canadian Oral Health Strategy (COHS) recommends “an increase in alternative delivery systems to complement private oral health delivery, addressing needs that are currently not being met.”1 The COHS also believes that education, health promotion and awareness activities will create the greatest improvements in oral health.1 Population wide strategies will be required to accomplish this, a job public health programs are well suited to perform. The challenge faced by all public health programs is implementing the best strategy with limited resources. The IH Dental Program (IHDP) used the concept of the right services delivered at the right place, right time by the right people. In 2003, the IHDP began a pilot project that provided one-to-one service (interventions – right services) to parents attending routine childhood immunizations (the immunization schedule for infants in British Columbia is 2, 4, 6, 12 and 18 months, and at Interior Health, is adminis- Figure 1. Dental key messages. Figure 2. Tooth talk questionnaire. This issue of the journal proudly presents the conference proceedings of the CDHA national conference, Advancing Dental Hygiene Practice, held in Halifax, Nova Scotia, from 9 to 11 June 2011. short papers – The short papers that follow are the summarized oral presentations delivered at the scientific sessions of the conference. All these short papers are peer reviewed. 2 month: mouth cleaning and bacteria transfer 4 month: tooth cleaning and teething 6 month: tooth cleaning, sleep/nap time with a bottle, introduce cup 12 month: tooth cleaning, cup only, first dental visit 18 month: tooth cleaning, between meal thirst 166 2011; 45, no.3: 165–178 cdha national conference proceedings – Short papers 0% 20% 40% 60% 100% 80% % of questionnaires Number of interventions High risk Moderate risk Low risk 0 1 2 3 tered by public health nurses at child health clinics (CHC) Figure 3. Risk levels. in urban locations – right place). After every immunization, parents are encouraged to remain at the clinic for a short period of time, which gave the dental staff the opportunity to engage in conversation with them (right time, right people). Delivery Key messages, specific to the age of the infant based on the immunization schedule, were developed (Figure 1). At the CHC, dental staff would have one-to-one discussions with parents on the age specific key message. The 12-month visit included a questionnaire (Figure 2) to determine the risk level of dental behaviour. The levels of risk were low, medium or high based on the responses given in the Tooth Talk Questionnaire (TTQ). Results The project had several goals including seeing what effect the interventions made in children’s oral health outcomes. The evaluation of the pilot project showed that clients valued the services provided by having dental staff present. This resulted in continued dental staff involvement at the Penticton CHC, British Columbia. While the public’s appreciation of the services was welcome, determining if the multiple brief interventions could influence dental health outcomes in children was a key consideration for the long term success of the project. By keeping track of how many prior interventions each family/child had before completing the TTQ, it was possible to compare the risk level to the number of interventions. Between 2005 and 2010, 1664 TTQ were collected and analysed. Findings have shown that the risk level based on the classifications from the questionnaires correspond to the number of prior interventions (Figure 3). The results for TTQs: 1. High risk figures were 63%, 53%, 42% and 33% for parents who had 0, 1, 2 or 3 brief interventions. 2. The overall average of high risk TTQ from the Penticton CHC was 44% whereas the average in areas that were not using the brief intervention strategy was 64%. Conclusions This strategy has shown that parents who receive more brief interventions tend to have increased dental knowledge for the risk factors contributing to early childhood caries. The hope is that this will translate into parents following best practices for oral health with their infants through to childhood; where once good oral habits are established, they will continue to be practised thereby improving the overall oral health of the population. References 1. Dental Working Group. Canadian Oral Health Strategy. Montreal. August 2005;6 http://www.fptdwg.ca/assets/PDF /Canadian%20 Oral%20Health%20Strategy%20-%20Final.pdf 2011; 45, no.3: 165–178 167 Short papers – CDHA national conference proceedings Oral care for adult survivors of childhood violence: Research based guidelines Schachter CL , MacDonald L, Richardson F. Candice Schachter, DPT, PhD Adjunct Professor, University of Saskatchewan Candice.schachter@uask.ca the principles represent absolute requirements for many survivors to be able to tolerate healthcare encounters. When continuously employed by the dental hygienist, the principles represent a simple yet profound way to support the survivor while carrying out dental hygiene care. Our research shed light on some types of triggers that survivors experience during healthcare encounters and identified ways of working with survivors to avoid or manage the triggering of memories of past abuse. Through one technique, termed “task specific inquiry”, the clinician enquires about sensitivities and discomforts specific to dental hygiene care. The goal is to establish a dialogue about what the dental hygienist can realistically do to minimize these difficulties during care to work more effectively with the client. Task specific enquiry enables survivors to disclose as much as they are comfortable revealing, and allows the dental hygienist to put the information to good use to facilitate feelings of safety during care. Our findings support the use of task specific enquiry by the dental hygienist, both initially and on an ongoing basis, to facilitate the client’s feeling of safety. This project also indentified a method of responding to ‘difficult situations’ for example, when a client’s reaction to some component of care seems to be disproportionate to what the dental hygienist thinks is going on. The SAVE method (Stop, Appreciate, Validate and Explore) can be broadly used in any type of difficult situation with the aim of reestablishing a client’s feelings of safety and proceed with oral health care. Workshops on Sensitive Practice have been facilitated with dental hygiene students at the University of Manitoba and with dental hygienists and dental hygiene educators in Ontario. Feedback from participants confirmed the vulnerability that survivors may experience during oral healthcare interventions, and reinforced the relevance of Sensitive Practice for all dental hygienists, students, and educators. Conclusions Our research findings are consistent with studies that have used quantitative methods to examine dental fear among adult survivors. Sensitive Practice is fine tuning of client centred care for adult survivors of childhood violence. The high prevalence rates of abuse and the knowledge that survivors may not disclose past abuse suggest that dental hygienists should use Sensitive Practice with all clients at all times. The Handbook1 outlines Sensitive Practice background, principles, and guidelines for use by all dental hygienists, students, and educators. Reference Public Health Agency of Canada - National 1. Clearinghouse on Family Violence. Handbook on Sensitive Practice for Healthcare Practitioners: Lessons from Adult Survivors of Childhood Sexual Abuse. Ottawa. 2009. Research reporting that at least 1 in 5 women and 1 in 7 men is a survivor of childhood sexual abuse strongly suggests that dental hygienists work frequently, and mostly unknowingly, with adult survivors. Objectives This multidisciplinary qualitative research project used grounded theory and action research to bring together survivors and healthcare providers from across Canada to develop guidelines that all heathcare practitioners can use to improve survivors’ healthcare experiences. Method 109 women and men survivors were interviewed about their experiences with healthcare providers. Working groups of survivors and healthcare providers used this information as the basis of discussions of how healthcare providers can work more sensitively with survivors of childhood violence. Findings became successive drafts of a Handbook, which were sent to survivor participants and healthcare practitioners in 10 disciplines from across Canada. Written and oral feedback was received and the resulting Handbook1 was published in 2009. Dental hygienists’ input into this research was crucial to ensuring the Handbook 1speaks to all dental hygienists. Results The Handbook1 outlines survivors’ difficulties when accessing healthcare and presents nine principles of Sensitive Practice and additional guidelines to improve client care. Survivors’ commonly identified difficulties when seeing healthcare providers were: fear of abuse by the clinician, fear of judgment, distrust of authority figures, need to feel ‘in control’, physical pain, discomfort with clinicians of the same gender as the abuser(s), disconnection from or ambivalence about the body, conditioning to be passive or aggressive, triggers, and dissociation. Any and all of these difficulties can be experienced during dental hygiene care. Survivors strongly expressed that feelings of safety are crucial when seeing a healthcare practitioner. Nine principles represented the most significant contributors to feelings of safety for survivors: respect, taking time, rapport, sharing information, sharing control, respecting boundaries, fostering a mutual learning process, acknowledging that healing from abuse is not a linear process, and clinician’s demonstration of an awareness of the prevalence and long term effects of violence. While many of these principles represent tenants of good client centred care when considered within the context of childhood abuse, 168 2011; 45, no.3: 165–178 cdha national conference proceedings – Short papers Mouthwashes and their effect on global health Louise Bourassa, HD , BA, MA Educator, College Francois-Xavier Garneau, Quebec lbourassa@cegep-fxg.gc.ca Nadia Dubreuil, HD Educator, College Francois-Xavier Garneau, Quebec ndubreuil2@cegep-fxg.gc.ca acidic, 26.2% (21/80) of mouthwashes are moderately acidic, 11.2% (9/80) are acidic, 16.3% (13/80) were neutral and 2.5% (2/80) were basic. It is very pertinent to ask whether there are side effects on teeth and soft tissues associated with the daily use of oral hygiene products whose pH value is acidic. It is recognized that regular exposure to an acidic substance (soft drinks, energy drinks, repeated vomiting) may be harmful to dental tissues. Potentially, most mouthwashes may create a demineralization of teeth. In case of loss of tooth structure (abrasion, abfraction, erosion) or tooth sensitivity, it is strongly recommended to limit exposure to acids. Dental hygienists are aware of the factors that contribute to hyposalivation, for example, the side effects associated with consumption of certain drugs or the exposure of the salivary gland to the radiation treatments or Sjogren’s syndrome. Moreover, dental hygienists are educated on the long term consequences of hyposalivation on the oral cavity—high susceptibility to decay, difficulty eating and swallowing, halitosis, to mention a few. Other variables influence the potential loss of tooth structure, such as the frequency, time of exposure to mouthwash, the amount of saliva and its buffering capacity, hardness of teeth, presence of root exposure, health habits using toothpaste or a very abrasive toothbrush or an inadequate technique of toothbrushing. If an acidic mouthwash is used prior to brushing, for example, use of whitening mouthwash or a mouthwash before brushing, could this increase the loss of tooth substance? Potentially, yes. Thus, the products themselves have a high risk potential. This risk increases with the combination of several factors that have a synergistic effect, such as mechanical brushing using abrasive toothpaste with a low pH value, or using a low pH value mouthwash, or the 0 5 10 15 20 25 30 35 40 35 (43.8%) 21 (26.2%) 9 (11.2%) 13 (16.3%) 2 (2.5%) Very acid (0 to 4.5) Moderately (4.51 to 5.50) Acid (5.51 to 6.50) Neutral (6.51 to 7.99) Basic (8.0 to 14.0) Objectives The purpose of this study is to determine the pH value in mouthwashes, and to investigate their effects on the dentition and global health of clients. Methods The materials used were acidimeter, three standard solutions (acid = 4,000, neutral = 7,000 and basic = 10,000), magnetic agitator, magnetic plaques, distilled water, thermometer, chronometer and calibre glasses. The protocol consists to do two calibrations. The temperature of the solutions ranged between 21 and 23 degrees Celsius. Three tests were realized with 60 ml at 350 speeds. If a difference between 2 measures was 0.1, another calibration was taken. Data were obtained by statistical analysis using Excel. Results First results on mouthwash indicated acidity up to 2.5 pH with or without alcohol. The first generation of mouthwash was cosmetic; those available now contain therapeutic agents to reduce such oral health problems as gingivitis, calculus, cavities, xerostomia, and stains above the appropriate dose. The authors undertake to disseminate the results on a website to allow dental hygienists to easily access and respond to customer needs. Few case studies will be included to help oral health professionals choose the best products for their clients with their own characteristics. About eighty products were tested between 2010 and 2011. These 80 products were divided in a pH scale ranging from 0 to 14: very acid (0 to 4.50), moderately acidic (4.51 to 5.50), acidic (5.51 to 6.50), neutral (6.51 to 7.99) and basic or alkaline (8.00 to 14.00). Literature has shown that the enamel composed of fluorapatite crystals is stronger than enamel composed entirely of crystals of hydroxyapatite (new tooth present in the mouth), and that it requires a pH value below 4.5 to be compared with demineralized pH 5.5 for a non fluoridated enamel. Dentin and cementum are more fragile, and their demineralization begins from a pH value of 6.5. For values greater than 6.5 up to 7.99, they are considered neutral (7 plus or minus 1). Products with a pH value above 8 are basic and are very rare on the market. From the analysis of our statistics, 70% of mouthwashes were at a moderately acidic pH value or very acidic, below the critical level of 5.5. Of these, 43.8% (35/80) are very N: 80 Source: Paquet MJ, Dubreuil N. 80 products tested and their pH. 2011; 45, no.3: 165–178 169 Short papers – CDHA national conference proceedings consumption of beverages or acidic foods. These isolated oral hygiene habits seem trivial, but in combination they can become a risk factor rather than a protective factor. For example, a low pH value mouthwash without ion remineralizing, such as a therapeutic agent known to be effective against gingivitis, could become a risk factor to erosion in a client with exposed roots. It is prudent to recommend the use of mouthwash at the end of the brushing and flossing, to extend the benefits of toothpaste to prevent toothpaste ingredients interfere with those of the mouthwash. As for erosive beverages or vomiting, it would also be desirable to consider an interval of 30–60 minutes between brushing and acidic mouthwash in future recommendations. Therapeutic ingredients may be the subject of a forthcoming presentation of scientific papers and subsequent research. Ideally, in vivo studies would be very interesting to confirm or disprove the hypothesis of potential tooth loss by mouthwashes that are used alone or in combination with other products. The findings of the research group of College François-Xavier-Garneau suggest a toothbrush, toothpaste, or mouthwash seems most relevant to better suit the characteristics of each client. Conclusions Some solutions will be proposed to reduce enamel loss during acid exposition. For example, erosion, sensitivity in relation with exposed dentin can increase if clients brush their teeth immediately with an acidic mouthwash. Thus, the daily use of mouthwash at acidic pH values is questionable. Dental hygienists will appreciate new perspectives about mouthwashes, in future research. Characteristics that place dental hygienists at risk of providing substandard client care: Findings from Ontario’s Quality Assurance Program Jane Keir, RDH , BSc, BEd Administrator of Quality Assurance, and Practice Advisor College of Dental Hygienists of Ontario jkeir@cdho.org site review of her/his dental hygiene practice. If required, the Committee will order specified continuing education and/or remediation program related to the areas in which deficiencies were identified. Method The CDHO’s QA records for the past twelve years were analyzed to determine if there were commonalities among dental hygienists who scored poorly on an on site practice assessment. A total of 237 records were examined for characteristics that included year of graduation, practice location, number of days worked per week, and solo or group practice. Registrants were grouped into 5-year cohorts based upon years since graduation from their dental hygiene program. Urban practices were identified as those in areas with a population greater than 100,000. Registrants who worked four or more days per week were considered to be practising full time while those who worked three days/ week or less were considered to be practising part time. Results Analysis of the QA records suggest that the dental hygienist at the greatest risk of practising below standards and/or providing substandard client care is one who has been in practice between 16 and 20 years. Of those dental hygienists undergoing an on site review, 84.4 % practised in an urban location while 72.2% worked in a solo practice. No statistically significant difference was identified between those who worked part time (52.7%) and those who worked full time (47.3%) at the time of portfolio submission. Examination of the records revealed that 73% of unsuccessful registrants were required to undergo remediation in ethics and/or jurisprudence, 71% in record keeping, 69% in process of care and 32% in infection con- Objective To investigate whether there are common characteristics among those dental hygienists who practise below acceptable standards. Background The Regulated Health Professions Act 1991 requires all health regulatory colleges in Ontario to develop and to maintain a quality assurance program to ensure the provision of safe and effective quality dental hygiene care to the public. The College of Dental Hygienists of Ontario (CDHO) designed its Quality Assurance (QA) program to promote and monitor continuing quality improvement among its registrants. The cornerstone of the QA program is the requirement that all registrants establish and maintain a professional portfolio. Compliance with this requirement is a mandatory requirement for the annual renewal of their certificate of registration. Each year, 10% of the active registrants are randomly selected to submit their portfolio for a peer review. Upon review by a QA assessor, registrants who have been identified as having deficiencies in their portfolio related to their dental hygiene practice undergo a telephone interview to provide them with an opportunity to clarify identified deficiencies. If the QA Committee is unable to confirm that the registrant has met the criteria for a satisfactory portfolio and/or if concerns are brought forward from other information before it, the QA Committee requires that the dental hygienist undergo an on 170 2011; 45, no.3: 165–178 cdha national conference proceedings – Short papers Meeting the challenge of responding to abuse of older adults: A survey of tools being used by diverse frontline responders Objectives This presentation provides an overview of the intent and outcomes of Elder Abuse Knowledge to Action Project carried out by the National Initiative for the Care of the Elderly (NICE). The purpose of the project is to involve meaningfully older adults in all aspects of the project including raising community awareness of abuse of older adults and the successful introduction of evidence based detection, intervention and prevention tools into the practice of professional and community responders. Methods Detection, intervention, and prevention tools were selected based on input from the Elder Abuse Team and Seniors Advisory Council within NICE, the project’s senior coordinators and a diverse array of practitioners/ responders from across Canada who participated in Alison Leaney, MS W, RS W alison.leaney@nicenet.ca teleconferences or completed training forum evaluation forms. Respondents were asked what tools they are using and the areas in which tools are needed to assist them to address/prevent abuse of older adults. Results This session highlights the tools selected for sharing across Canada in pocket card format, and the processes employed to maximize uptake by the various intended users. Preliminary evaluative data will be made available based on preliminary analysis of training forum evaluation forms, follow up online surveys and selected interviews. This session augments the other session being offered in relation to the CDHA Elder Abuse Awareness Professional Development Program Outcomes The process by which the various tools are being integrated into practice will be described and summarized as Lessons Learned for effective Knowledge Exchange. trol. The majority of registrants were required to complete remediation in multiple areas of deficiency. Conclusion Common characteristics have been identified that will provide insight helpful to regulators, educators and individual dental hygienists, and to QA programs. A direct relationship appears to exist between the results of this analysis and that of the Total Quality Improvement (TQI) study undertaken by the CDHO in 2002. In this study, dental hygienists who performed below the provincial average were found to be less likely to participate in continuing quality improvement activities related to record keeping or to participate in the design of the client record forms being used in their practices. They were also less likely to study the dental hygiene process of care. The relationship of the findings of this analysis with the perceptions of dental hygienists taking part in the 2002 TQI study regarding infection control, appear to be less clear. The 2002 study indicated that four out of ten dental hygienists worked in a practice with a written infection control policy while only six out of ten indicated that compliance with the policy was regularly monitored. The frequency of completing continuing quality improvement activities related to infection control was not collected or reported. The 2002 study also did not directly address issues related to ethics and/or jurisprudence. The characteristics identified in this analysis as indicators of risk will assist groups and individuals who wish to take a proactive approach to quality assurance and continuing competency. Regulators may use the information to develop a targeted approach in the development and promotion of future policies and programs aimed at improving the quality of care delivered to dental hygiene clients and in developing materials to assist registrants in this regard. Education programs may also be targeted to meet the needs of the groups at risk and individual dental hygienists who are in the groups identified as being at risk may use the information to assist and guide them in their self assessment and in choosing future continuing quality improvement activities. 2011; 45, no.3: 165–178 171 Short papers – CDHA national conference proceedings Dental hygienists in interdisciplinary healthcare for the homeless Ruth McMullan, BEd, RDH Educator, Niagara College, Ontario rmcmullan@niagaracollege.ca Introduction What began as a simple question, What can we do about the oral health of the homeless and less fortunate in our community? rolled into a community project involving dental hygiene students, educators, advisory committees, dentists, and staff at the shelters. Plans were made to meet with the officials at the shelter in St. Catharines to discuss some possibilities for our students. A committee was formed, which included among others, local dentists and dental hygienists; I was nominated “Chair”. Objective To establish a dental clinic for the homeless and to advocate for their oral health. Methods Two committee members decided, at first, to visit two shelters in Toronto which had dental clinics to gain from the models they worked. During the process, the idea of investing in a portable unit at the St. Catharines shelter advanced to installing a dental unit at the new Community Health Centre (CHC) in St. Catharines. Our advisory committee took on a new role with our relationship with the Centre and dental care became part of the interdisciplinary care for their target population. Observations CHCs are “non-profit, community-governed organizations that provide primary health care, health promotion and community development services, using multidisciplinary teams of health providers.” Utilizing the different professions, as you assess and plan for an individual’s treatment holistically, benefits the client. Individuals within a priority population will not go to a dental office out of fear and lack of money. A Swedish study indicated that the majority of clients would visit a dental clinic in a shelter, rather than in an office. At the CHC, individuals would receive assistance from doctors, nurse practitioners, social workers, dentists, dental hygienists and others. As a dental hygienist, being able to utilize this team for referrals and consultations would be part of the complete care for each client. The reward of helping someone in need is self rewarding as you learn from others and give back to those less fortunate. Challenges There were a few challenges that we encountered. One that surprised me was the question from local dental hygienists: “Can self initiated dental hygienists volunteer in a community health centre?” The College of Dental Hygienists of Ontario verified that we could provide “primary, interceptive, therapeutic, preventive, and ongoing care procedures” that would enable this population. Another challenge involved advocacy for our cause. I had the opportunity to speak to our local MPP about dental care in the CHC. He told me that he was behind the project 100% and understood that the “priority” population needed our help. What a relief! Results Our committee had to review the capital and operational aspects for the dental area. The CHC received a grant, through the local health unit, and with that, we have two complete dental units, lab, and digital radiography equipment. Currently the committee is organizing fund raisers and other venues for financial support. The dental clinic opens in the Fall of 2011. The committee will be contacting dental hygienists and dentists to volunteer. A full time dental assistant will be hired. Where do we begin to find volunteers? There is nothing more successful or effective in getting the word out about something than through warm networks. Our committee is working on putting a list together of those we know, trust, and respect and those who will listen. Conclusion As dental hygienists, many of us take our profession and give back to those less fortunate outside of our day job. It isn’t about the money you make in your day job, but about volunteering and helping with your time and experience. How do dental hygienists work with other professions? Take an idea and get involved. The St. Catharine’s Health Centre, Quest, will be a model of how different professions can all work together to provide care for the client’s mental, social, physical, and dental health. The journey, the quest for individuals to have an opportunity to have a better life, began when a police officer approached me with the question, “What can we do about the oral health of the homeless and less fortunate in our community?” Our committee assessed the need, researched, and planned. The CHC has two dental operatories for hygienists to provide and implement preventive care to this priority population within an interdisciplinary environment in St. Catharines. 172 2011; 45, no.3: 165–178 cdha national conference proceedings – Short papers Interprofessional collaboration, a community of practice and research capacity building: Just how and where to begin for the dental hygienist involved in interprofessional practice Dental hygienists worldwide are committed to collaborative interprofessional patient/client centred practice.1 The need to advance and contribute to the knowledge base of interprofessional education for collaborative patient centred practice (IECPCP) is vital to healthcare, because although logically it makes sense that professional collaboration better meets the needs of the client/patient, the best practices and evidence base to support this logic are needed from a research and practice perspective. The activities and experiences of dental hygiene interprofessional collaborations need to be captured and disseminated throughout the healthcare community. What are the lessons learned? How does one measure success of such collaborations? Are there tools and strategies that work better than others? The research and evaluation of IECPCP and, in particular, the role of the dental hygienist within healthcare, are vital to defining and informing its way of being within healthcare. The World Health Organization (WHO) and the Canadian Interprofessional Health Collaboration (CIHC) have clearly stated that patient centred practitioners who collaborate promote better health outcomes for the patient and the healthcare system.2,3 Health professional programs are advancing the curricula to one that offers an interprofessional educational grounding with articulated standards and guiding principles of the interprofessional collaborative health professional.4 Such a curriculum prepares “collaborative-ready” practitioners.2 Dental hygiene programs, like the other health professional programs, have embraced the IECPCP curricula;5–7 hence the entry to practice dental hygienists are increasingly knowing themselves as interprofessional collaborative practitioners. Research capacity building (RCB) is a process and an outcome, a means to an end that promotes the active capturing of evidence based practice.8 It is recommended that dental hygienists assess what they are doing in a meaningful manner, based on reliable and valid assessment tools and strategies so as to capture the empirical outcome and the significance of that outcome to practice. Does the presence of a dental hygienist as part of an interprofessional collaborative healthcare team for a patient/client with cardiovascular disease make a significant difference to the quality and outcome of the client’s care? Cooke8 presents a two dimensional research capacity building framework for planning change and measuring progress. One dimension is the developmental activities of structural levels individual, team, organizational, and network, and the other dimension is the six capacity building principles—skills and confidence building, close to practice, linkages and collaborations, appropriate dissemination, continuity and sustainability, and infrastructures.8 Cooke’s framework helped a community of health professionals— administrators, educators (one of whom was a dental hygiene educator), practitioners, and graduate students—who were working together through the CIHC to help inform research and evaluation of IECPCP.9 The community recognized itself as a “community of practice” (CoP) defined by Wenger10 as a basic building block of a social learning system of a group of people who share a passion or a commitment and who purposefully interact together to deepen and expand their knowledge and ability to fulfill the passion and/or commitment.11 The framework and process employed gave the CoP purpose, direction, and determined the course of action: develop a research and evaluation agenda for interprofessional education and collaborative practice. The dental hygiene educator saw “building skills and confidence” and “being close to practice”, two of Cooke’s six principles of RCB, as speaking directly to the dental hygienist embracing IECPCP. The concept of a CoP furthered solidified the “place” and contributions to the advancement of health and well being the dental hygienist plays in advancing healthcare through IECPCP. Knowing the dental hygienist has a place and a contribution to collaborative practice for patient centred care starts with having the confidence to step forward and stay centred “close to one’s practice”; in essence, “know what you know; know what you don’t; know when to refer/consult”. Swanson Jaecks12 surveyed a convenience sample of over one hundred practising dental hygienists in Oregon, USA, to gather their perceptions regarding interdisciplinary collaboration and barriers in achieving it. Dental hygienists in Oregon are able to provide dental hygiene care under the “limited access permit” to persons in long term care facilities. The survey measured experience, confidence, leadership, knowledge utilization, and the role of dental hygienist in interdisciplinary collaboration. The results assure the profession that dental hygienists respect their current and future contributions to collaborative practice for client care. The top ranking barriers to achieving this were as follows: insufficient time, willingness of other professionals to collaborate, need for more professional freedom, and possessing insufficient knowledge about medical diseases/conditions. The first three barriers are common enough in IECPCP for many health professionals; 13 however, the dental hygienists’ perception that the profession has insufficient knowledge about medical MacDonald L, Sutter E, Lait J, Law R, Wener P, Khalili H, McCarthy P Laura MacDonald, RDH , DipDH , BSc(DCDH ), ME d Associate Professor, School of Dental Hygiene, Faculty of Dentistry University of Manitoba Laura_MacDonald@umanitoba.ca 2011; 45, no.3: 165–178 173 Short papers – CDHA national conference proceedings diseases/conditions as being a barrier to interprofessional collaboration is perhaps a misguided perception of what it means to be involved in interprofessional collaboration. The concept of “community of practice” invites dental hygienists to engage, imagine, and align their expertise in oral health promotion and oral disease prevention with that of other health professionals’ expertise and contributions to patient centred practice. Ways of participating or modes of belonging, as defined by CoP include engagement, imagination, and alignment; these lead to profiling of the competencies of the CoP.10 Interprofessional health collaboration, as a CoP, would thus define its competencies. The British Columbia Competency Framework for Interprofessional Collaboration has 4 key competencies: 1. Interprofessional and communication skills 2. Patient centred/family focused care 3. Collaborative practice (collaborative decision making, role/responsibility, team functioning) and 4. Continual quality improvement. These competencies are known all too well to the dental hygienist;14 the dental hygienist can confidently be part of IECPCP and contribute greatly to improving healthcare for one and all. References 1. Gurenlian JR. Summary of the International Federation of Dental Hygienists house of delegates workshop. Int J Dent Hyg. 2010;8(4):313–16. 2. World Health Organization. A framework for Action for Interprofessional Education and Collaborative Care. Geneva: 2010. World Health Organization Press. 3. Canadian Interprofessional Health Collaboration. What is Interprofessional Education? 2009. Retrieved 29 March 2011 from http://www.cihc.ca/files/CIHC _Factsheets_IPE_Feb09.pdf 4. Accreditation of Interprofessional Health Education (AI PHE ). Principles and practices of integrating interprofessional health education into the accreditation standards of six health professions in Canada. 2009. Funded by Health Canada. Retrieved 29 March 2011 from http://www.cihc.ca/files/complementary/AI PHE _Principlesand- PracticesGuide_2009.pdf 5. Mann KV, Mcfetridge-Durdle J, Martin-Misener R, Clovis J, Rowe R, Beanlands H, Sarria M. Interprofessional education for students of the health professions: the “Seamless Care” model. J. Interprof Care. 2009;23(3):224–33. 6. Anderson JA, Ateah C, Metge C, Wener P, MacDonald L, Fricke M, Davis P, Ludwig S, Snow W, Tryhuk L, Interprofessional Education for Collaborative Patient-Centered Practice: The Manitoba Initiative, Mission Possible. Journal of Research in Interprofessional Practice and Education. (in press 2011). 7. Ateah C, Davis P, Snow W, Fricke M, MacDonald L, Wener P, Ludwig S, Anderson A. Stereotypes in Health Professions: Does Interprofessional Education Make a Difference? Nurse Educ Today. 2010;31(2):208–13. 8. Cooke J. A framework to evaluate research capacity building in health care. BioMed Central Family Practice. 2005;27(6):44. 9. Suter E, Lait J, MacDonald L, Wener P, Law R, Khalili H. A strategic approach to building research capacity in interprofessional education and interprofessional collaboration. Healthc Q (in press). 10. Wenger E. Communities of practice and social learning systems. Organization. 2010;7(2):225–46. 11. Wenger E, McDermott R, Synder W. Cultivating Communities of Practice: A Guide to Managing Knowledge. 2002. Boston: Harvard Business School Press. 12. Swanson Jaecks KM. Current perceptions of the role of dental hygienists in interdisciplinary collaboration. J Dent Hyg. 2009;83(2):84–91. 13. Légaré F, Stacey D, Brière N, Desroches S, Dumont S, Fraser K, Murray M, Sales A, Aubé D. A conceptual framework for interprofessional shared decision making in home care: Protocol for a feasibility study. BMC Health Serv Res. 2011;11:23–30. 14. Canadian Dental Hygienists Association (CDHA ). Entry-to-practice Competencies and Standards for Canadian Dental Hygienists. 2010. Retrieved 29 March 2011 from http://www.cdha.ca/pdfs/ Competencies_and_Standards.pdf Dental Hygiene curriculum: An investigation of novice dental hygienists’ assessment of how prepared they were for the transition from student to clinical practice Lisa Taylor, RDH , BA, BEd Associate Registrar, College of Dental Hygienists of Ontario for at least 1200 hours. Seven volunteer dental hygienists were asked to reflect on how prepared they felt they were for clinical practice following entry-to-practice. A semi structured interview technique was used to solicit recollections, perspectives, and opinions to gain an understanding of how prepared graduates of the present curriculum felt they were for dental hygiene practice. Results The findings of this study suggest that current dental hygiene graduates are not appropriately prepared for the transition from student to practitioner. All seven study participants reported struggling to work within the dental hygiene concept of client centred care while trying to serve dentists who were focused on maximizing dental hygiene Objective This was an exploratory, descriptive, and analytic investigation of novice dental hygienists to determine if they felt their education was effective in preparing them for clinical practice. Method Novice dental hygienists are defined as dental hygienists who graduated within the previous two years from an Ontario institution and who had an opportunity to practise 174 2011; 45, no.3: 165–178 cdha national conference proceedings – Short papers revenue. All participants reported that conforming to the standardized client appointment time while attempting to meet client needs was the most difficult part of their transition to practise. Recordkeeping requirements of dental hygienists, essential to the dental hygiene process of care and to the autonomy of dental hygienists, was mentioned by all participants as problematic during their transition. Their experience was that office scheduling did not allow them to write the breadth and depth they had become accustomed to in school. Many described second guessing themselves about what needed to be charted especially when questioned by dentists who thought the dental hygienists were taking up too much time and using too much space in the client charts. All participants in this study reported being ill prepared for the expectations around the use of technology. Six of the seven participants were intimidated by the ultrasonic scaler. While it would be unlikely for a dental hygiene operatory not to include this tool, participants reported that school clinics had a limited supply and that the equipment was usually reserved for clients with heavy subgingival deposits. Another theme identified in this study was the inadequacy of the pharmacology component of the dental hygiene programs. While the interviewees reported not knowing enough about the medications their clients were on, they had equal concern that they did not know how to use antimicrobial agents or antibiotic preparations as part of client care. Six of the seven study participants suggested that they were not prepared at entry level to be the communicators they needed to be, although they felt that those with dental assisting backgrounds had less difficulty. However, they were of the opinion that this communication skill would improve with increased work experience. Six of the seven participants were unprepared for the billing issues requiring knowledge of procedure specific insurance codes. Five participants reported feeling intimidated by dentists and other office staff to bill more units of time than they felt was appropriate and that were not adequately prepared to handle these situations. All participants placed an emphasis on the advantage dental assisting experience had on their success. Their experience was that classmates who did not have a dental assisting background were at a severe disadvantage because of their teachers’ expectations that students had this knowledge. This was true of both the community and the private career college graduates. All participants described a need for less summative and more formative evaluations during the program. Five of the six participants who were graduates of private career colleges reported that the majority of their instructors had clinical experience but had little if any teaching experience. Their common concerns were that teachers seemed ill prepared, inexperienced, and not engaged in student learning. Three of the participants were critical of their instructors’ attitudes towards students and cited authoritarian practices, and use of power and influence to convince students that their claim of expertise and status was legitimate. The dental hygienists interviewed for this study reported difficulty finding employment admitting that they limited their applications to general dental practices. All reported not having the knowledge or the skills at entry level to apply for jobs in public health, or in specialty practices. In addition, all but one indicated that they lacked confidence in treating clients who were medically, physically, or mentally challenged. Six out of seven reported that they had limited or no clinical experience treating special needs clients during their dental hygiene programs. Participant interviews indicated that there were greater challenges for graduates of non accredited programs in how prepared they were for the NDHCB examination. Both participants from the non accredited program described themselves as “self-taught” having formed study clubs and purchased textbooks not included in their curriculum to augment perceived gaps in knowledge. In addition, both reported using social media such as YouTube and dental companies’ websites to learn instrumentation techniques. During the transition to practise, participants reported using several methods to address deficiencies in knowledge and skill such as non formal mentoring, self study, study clubs, and post graduate courses. Conclusion This study suggests that dental hygiene graduates are not socialized to the contradictory social relations that dominate the dental field nor are they given the proper tools to prepare them for the dissonance between school and practice, nor to deal with other professions who will cause them to doubt the validity of their knowledge in an effort to have them accept their subordination to the hierarchy of the medical model. Dental hygiene students’ limited exposure to special needs clients and alternative practices including independent practice, serves to encourage graduates towards the traditions of dental practice that place their professionalism as inadequate. 2011; 45, no.3: 165–178 175 Short papers – CDHA national conference proceedings Going on your own: Results of a survey of dental hygienists who have opened their own practices Fran Richardson, RDH , BSCD , MED , MTS Registrar, College of Dental Hygienists of Ontario frichardson@cdho.org is informally partnered with a dental office, yet sees clients on referral from other practitioners. The primary reasons for conducting the survey was to find out: 1. why dental hygienists chose independent practice 2. their perceptions of the advantages and disadvantages for the client 3. the type of practice setting they own 4. what advice they would give to others who were interested in exploring that possibility, and finally, 5. to hear some of their success stories. Not surprisingly, the dental hygienists who responded to the survey indicated that they had been practising the profession for a significant period of time, with a mean of 20 years, a minimum of 5 years, and a high of 32 years. Most of the respondents indicated that it was their desire to practise dental hygiene in a manner acceptable to them that prompted them to start their own businesses, rather than an employer. Another prominent reason was to serve clients who, for a variety of reasons, had difficulty in attending a traditional dental office. Many of the respondents indicated that they offered mobile services and travelled to the client rather than having the client travel to them. A number of the respondents stated they believed that, as independent practitioners, they could provide the client with more individualized care, oral health education, and time. None of the respondents indicated that money was a prime motivator for going on their own, though several did say that they were “tired” of working for someone else who, they believed, did not appreciate preventive oral care in the same way in that they themselves did. According to a recent article in the Journal of the Canadian Dental Association, a survey conducted by the Canadian Dental Association indicated that “Many [members of the public] believe that the hygienist “cares” more than the dentist, a perception based on the amount of time the hygienist spends with the patient compared to the dentist.” The advice given by the dental hygienists with respect to setting up their own practices varied, but all had the common themes of doing one’s homework and limiting expectations for rapid growth. It was clear that the ones who felt they were experiencing financial success had been practising in this mode for the longest time. However, when it came to measuring success by way of client acceptance, some of the stories are truly remarkable. The presentation includes a number of quotes from the participants in the study. Dental hygienists in various jurisdictions were asked to complete an e-mailed questionnaire that provided space for answering open ended questions. Information was sought on number of years of practice prior to going on their own, reasons for that choice, type of practice setting chosen, barriers encountered, advantages and disadvantages for both the clients and the practitioner, success stories and challenges. Results indicate that dental hygienists who chose to venture out on their own have been practising the profession for a mean of 20 years with a minimum of 5 years and a high of 32 years. There are a variety of practice choices with some choosing to open a “store front” practice alone or with another health professional. Some respondents do mobile practice only or combine that with another form of practice. The dental hygienists’ reasons for choosing to go on their own are varied but the common themes are: 1. the ability to practise as they choose, 2. to practise to the standards set by their own regulatory body, and 3. to meet the needs of clients who were unable or unwilling to attend a traditional dental practice. Other findings relate to the barriers that the respondents continue to face and their recommendations to others who may wish to follow this path. A number of anecdotal success stories illustrate how these dental hygienists have touched other people’s lives. Dental hygienists in Canada have traditionally worked as employees. The most prominent employment setting is within a private dental office; yet there are dental hygienists employed in public health, education, hospitals, administration, and research. Due to recent legislative changes, dental hygienists in several jurisdictions in Canada are now able to open their own dental hygiene practices. While this choice of practice setting is not for all members of the profession, a number of dental hygienists have chosen to invest in the opportunity. The author conducted an informal e-mail survey of dental hygienists in Canada who indicated that they owned their own practices. The majority of the respondents were from Ontario, with a few from Alberta and British Columbia. One dental hygienist in Britain has a unique arrangement whereby she 176 2011; 45, no.3: 165–178 cdha national conference proceedings – Poster presentat ions Developing an oral health education program for personal care providers using an interactive consultative approach Janet Munn, RDH , RRI munnj@algonquincollege relevant educational topics and special support required to enhance the provision of personal daily mouth care. Ideas were modified with direct feedback from end users. Evaluation forms and periodic diary studies were collected. Results The following oral health education topics were established and presented at each site: • Oral health: The basics • Caring for adults with dementia • Palliative care: Oral care, and • Specialty tools for extra special needs. An oral health toolkit prototype was developed that includes a process for individualizing patient requirements using detailed colour coded “care cards”. Evaluation of the program was positive. Outcomes Relevant knowledge translation products were developed that include: oral health education modules, with Power- Point presentations and DVD, for each education topic; direct messaging posters; individualized oral health toolkits for each resident, and a comprehensive program resource binder and website. Interprofessional learning modules for dentistry and dental hygiene students Nancy R. Neish, BA, DipDH , ME d; Cynthia A. Andrews, BSc, DDS nancy.neish@dal.ca Methods The topics chosen for the four modules are: Patient/ client co-management, Collaborative practice in the real world, Teamwork, and Tobacco dependence education. The modules are designed as two hour sessions. The format includes an introductory plenary session, small group work, and a reconvening plenary session where representatives from each of the small groups present their group’s activities. Each small group will comprise both dental and dental hygiene students. Results Evaluation forms will be completed at the end of each session and results will be included in the poster presentation. Outcomes To date, there have been few studies regarding interprofessional educational opportunities with dental and dental hygiene students. It is hoped that fostering these opportunities will enhance collaboration and mutual respect among oral health professionals. An action planning workshop was held in October 2009 with 35 stakeholders, researchers, and care providers to plan priorities for education, training, policy, and evaluation to support personal daily mouth care practices for frail older adults living in three long term care facilities. This knowledge translation/exchange initiative is part of an ongoing interdisciplinary community based research project in Nova Scotia, Oral Care in Continuing Care Settings: Collaborating to improve policies and practices. Objective To establish an educational program for personal care providers that includes support, tracking, and evaluation strategies. Methods Using an interactive consultative process, personal care providers were engaged in focus groups, informal discussions, and an action planning workshop to establish Objectives This presentation will describe interprofessional learning opportunities provided to dental and dental hygiene students attending the faculty of Dentistry at Dalhousie University during the 2010–2011 academic year. Organized as four educational modules, these learning opportunities are designed to encourage dental and dental hygiene students gain an understanding of their respective roles and expertise, and to learn how to work together to provide optimal oral healthcare to the community they serve. To facilitate the implementation of similar modules at other interested institutions, the poster presentation will provide a description of each module, including the learning objectives, the course format, content, and evaluation forms. Poster presentat ions – The peer reviewed posters were presented between the scientific sessions of the conference on 11 June 2011. The posters’ content follows. 2011; 45, no.3: 165–178 177 Poster presentat ions – CDHA national conference proceedings Evaluating outcomes for the School of Dental Hygiene, Dalhousie University Nancy R. Neish, BA, DipDH , ME d; Peggy J. Maillet, DipDH , BA, ME d nancy.neish@dal.ca Results Of the 164 graduates in the target population, accurate e-mail addresses were obtained for 140 graduates. The response rate to the survey was 51%. Results indicated graduates believed the program outcomes were met, showing a mean score of greater than 8 (out of a maximum possible score of 10) for all but one outcome that was scored 7.17, SD 2.2. Additional measures of program outcomes used included national board exam results, feedback from students and faculty reviewing the curriculum and determining whether the national dental hygiene competencies for entry to practice were being addressed in the curriculum. Outcomes Conclusions from the study indicate a need to have: 1. program outcomes operationally defined to enable adequate measurement, 2. multiple measures of program outcomes, and 3. accurate methods of maintaining contact with alumni. (This poster was presented at ADEA, March 2010.) A scoping review of periodontal disease and adverse pregnancy outcomes Alison MacDougall, RDH , DipDH alisonmacdougall@hotmail.com odontal disease and adverse pregnancy outcomes; however, association does not imply causation. Methodological inconsistencies such as varying definitions of periodontal disease and adverse pregnancy outcomes, small sample size, inadequate control of risk factors and confounders and unclear study designs strongly influence the validity of the findings and call some into question. Outcomes To date there is no evidence to support providing periodontal treatment during pregnancy to reduce the occurrence of an adverse pregnancy outcome. Preventive dental hygiene care during pregnancy has been shown to be safe and effective in reducing periodontal symptoms in pregnant clients. Dental hygienists should encourage their pregnant clients to seek non surgical periodontal treatment, especially during the second trimester. We recommend that larger, more methodologically rigorous studies using universally accepted definitions be undertaken to explore further the nature of any relationships between periodontal disease and adverse pregnancy outcomes. Objectives The purpose of this study was to determine the extent to which dental hygiene graduates perceived the program outcomes were being met at the School of Dental Hygiene at Dalhousie University. Methods The authors constructed a survey instrument when their literature review revealed there was no standardized protocol for evaluating programs. Opinio, an online survey tool, through Dalhousie University, was used to design the survey and statistically analyze the results. Graduates from the classes of 2006–2009 were e-mailed the survey that also included a letter describing the study and other necessary information to meet the requirements for informed consent. Objective Adverse pregnancy outcomes such as pre-term birth and/or low birth weight continue to be a significant cause of infant morbidity and mortality. The objective of this poster presentation is to examine the existing science on the relationship between periodontal disease and adverse pregnancy outcomes. Methods A search was conducted in the Cochrane, Medline, CINAHL, EMBASE, PUBMED and BioMed Central online databases. Of the 72 papers identified, 9 systematic reviews and meta-analyses met the inclusion criteria for our scoping review. Narrative synthesis was performed. Results Some studies have reported an association between peri178 2011; 45, no.3: 165–178 cdha national conference proceedings – Abstracts Keynote address Terry Mitchell, BSc, DipDH, MEd, CGN Terry.Mitchell@Dal.ca Success in the dental hygiene profession has been achieved through the work of small groups of dedicated and persistent dental hygienists. We are now in the process of being recognized as a bone fide, stand alone health profession. The opening address will highlight accomplishments to date, and how we use these successes to further advance our profession. Comparing the oral health findings from CMHS to those of Inuit Oral Health Survey Lisette Dufour, RDH lisette.dufour@hc-sc.gc.ca The Canadian Health Measures Survey (CHMS) led by Statistics Canada with the participation of Health Canada and the Department of National Defence has gathered useful oral health data from Canadians aged 6 to 79. The OCDO was approached by the First nations and Inuit organizations to conduct an oral health survey similar to the CHMS. Two separate surveys were using the same measurement tools as those of the CHMS. This presentation will compare the oral health issues of Canadians in general with those of Canadian aboriginal populations. Facing abuse of older adults Alison Leaney, April Struthers, Fran Richardson, and Christina Wolf This panel will talk about indicators, communications with your client, and how to liaise with other professionals; to be safe, effective, and ethical in working with this complex topic. The session includes an interactive segment to help illustrate how to deal with suspected abuse/ neglect. Motivational interviewing: Improving patient compliance Wendy Bebey, RDH, BS bebey.w@pg.com Motivational interviewing is a client centred approach, enhancing intrinsic motivation to change by exploring and resolving ambivalence. Originally developed in the field of addiction therapy, motivational interviewing has been increasingly applied in the health professions with a growing body of successful outcomes for tobacco cessation and diabetic control which can significantly impact oral health. Shedding new light on oral cancer Jo-Anne Jones, RDH jjones@rdhconnection.com There has never been a greater sense of urgency to adhere to close examination of the oral cavity for early discovery of mucosal abnormalities. Oral cancer ranks thirteen among commonly diagnosed cancers in Canada. Oral cancer typically is discovered in late stages with a 5-year survival rate of 30%. The extraoral and intraoral examinations will be reviewed as well as an introduction to an innovative device recognized by the World Health Organization to address this global health concern. Dentin hypersensitivity: Effective clinical management Dr. Brian N. Feldman, DDS, BA brian_feldman@colpal.com The increase in enamel erosion, patient aging, gingival recession, and periodontal disease have resulted in an increased occurrence of dentin hypersensitivity. Correct diagnosis and effective treatment are critical to relieving a problem that can seriously affect a patient’s quality of life. This lecture will provide an overview of the biology, current treatment, and new approaches to managing this common patient problem. The long and winding road to Private Practice Ann Wright, RDH, MBA awright@cdha.ca This informative session will take you through ten top things you need to know before setting up a private practice. We will review the important practical and personal factors that impact the success of your practice with numerous anecdotes on real life challenges that dental hygienists face. This session will provide practical roadmaps for making your dream a reality. Abstracts – This section presents the Abstracts of the speakers’ presentations of the plenary sessions on 10 June 2011.

Backed by policy, advocacy, and legislation, opportunities in the second decade of this millennium are throwing open doors to wider scope of practice for dental hygienists in Canada. Dental hygienists today are riding the successes of decades of work that our pioneers in the field of dental hygiene paved for us. We owe ourselves the responsibilities to carry forward the principles of our profession, and re-evaluate our roles as dental hygienists in the wider world of overall health. 1. Consultation, education, chartings, health history, medical changes, and updates You should be updating and reviewing each client, every visit. It only takes a few minutes and is essential in determining overall possible links to periodontal disease and other dental conditions. Are you involved in the initial treatment planning? Are you regularly educating clients about oral disease and links to general health? Do you have a protocol for updating health histories and taking X-rays? 2. Periodontal risk assessments These assessments are of extreme importance to determining therapeutic options for clients. Complete annual periodontal charting including measuring of bone loss, pocket depths, recession, furcation involvement, mobility, abrasion and/or any other defects found. Plaque indexes, bleeding/inflammation indexes, oral hygiene indexes, taking, updating and interpreting X-rays, and DNA testing of subgingival bacterial colonies help evaluate the status of health or disease of a patient. These findings should be evaluated during the first several visits and then monitored at each consecutive visit. How comfortable do you feel in implementing periodontal treatment? Do your skills need to be optimized, improved, or renewed? 3. O ther risk assessments Caries risk assessment including caries detection and control, DNA saliva and sulcular fluid testing, nutritional analysis, smoking cessation, oral cancer screening, intra and extra oral examinations are also important to the general health of patients. They are carried out when the patient shows signs of high risk factors contributing to each specific condition. Have you implemented any of these advanced screenings into your oral health programs? 4. T herapeutic treatments After assessing the client, a dental hygienist must develop an individual treatment plan. General light plaque debridement with ultrasonic power scalers and some hand instruments, polish, including air and manual, and some oral care instructions can be split as two appointments depending upon the condition of the disease and time allotment. Non surgical periodontal treatment (curettage) and presurgical periodontal treatment (soft and hard tissue curettage) which uses hand instruments for removing rough root surfaces and dead tissue in deep pockets can be completed in multiple separate visits. Are you advancing your skills for periodontal therapy? Are you using the latest instruments and techniques for optimal treatment results? Take some time this month to re-evaluate your role as a key part of a dental team. Answering these questions will help you determine some professional goals for this new decade. Think about the following questions: 1. Do you like what you do? Is it fulfilling or a bit boring? 2. Is your job just a job or a career/profession? 3. Are you working to your full potential? 4. How is your relationship with the dental team? Can it be improved? 5. Do you work as part of a team or as an individual in it? 6. Do you have or are you interested in opening your own independent practice? 7. Who do you network with? Do you have good dental contact lists and referral practices? 8. How many continuing educations courses have you attended each year? 9. Do you implement this information regularly to your practice or just attend courses for the credits? 10. Are you working with modern technologies and equipment? 11. How effective are your communication skills? 12. Do you think you are a good motivator for your clients? 13. What can you do to create a more successful dental team and practice? We should then assess our clinical duties and how we align ourselves with the workflow. Think about how you can involve the dental team and what you can improve and update this year. Your current familiarity with the various methodologies, therapies and techniques, and how you implement them within your treatment plans are part of this self assessment. 2011; 45, no.2 83 e d i t o r i a l Dentistry as we knew it twenty years ago has changed. A profession that was primarily mechanical and repair oriented is developing into a medical profession. It is not about trying to treat many people in a short time period. Research is bringing forward increasing links between the oral cavity and systemic diseases. Studies and statistics are providing us with more information as to the bidirectional relationship of periodontal disease and systemic conditions.¹ Therapies will take more time and be more involved than previously. Therefore, the role of the dental hygienist has changed. We now know that periodontal disease is an inflammatory disease.² Health or disease of the oral cavity can contribute to the overall status of such systemic conditions as diabetes, heart disease, and circulatory problems, and in some cases can even effect medical treatments. The improved life expectancy and the increase in older population grow with the increase in health issues and systemic diseases.³ The need for oral health and care is more important than before. Knowing how oral disease is linked to systemic conditions is vital for individual treatment planning. The more systemic complications a client has, the more diligent a dental hygienist must be when recommending therapeutic options specific to that client’s needs. More time and treatment sessions will be needed to complete the therapy therefore increasing the time and money a patient will have to invest in his/her dental treatment. This must be explained, educated and “sold” to the client, so your communications skills must be at their best. As well, working with latest technologies, systems and updating hands on skills determine success of therapy. A dental hygienist is no longer a “tooth cleaning person” as was believed in the past. Our duties are complex and multifaceted. We must wear many different hats: consultant, confidant, guidance counsellor, teacher, educator, oral therapist, trusted person, visionary, technician, motivator, conservative periodontal specialist, brand manager, sales representative, team leader and psychiatrist are some of the roles dental hygienists occasionally slide into. A dental hygienist is a health professional, and respects the clients and the entire dental team. Advance communication, people skills and compassion are valuable leadership skills. Cotreatment planning with the dentist, support of dental team, motivation and education of clients, along with application of new therapies, treatments, and products are valuable characteristics of a good dental hygienist. Flexibility and good listening skills will help develop a step by step plan for treating and guiding patients to a stable oral condition and possibly reducing risk factors that lead to other systemic conditions. I encourage you to review your duties as a dental hygienist, make some goals and plans to improve your skills, update your knowledge and apply modern therapies to become that dental hygienist you started out to be. It is not just about cleaning teeth anymore. It is now about saving lives.

Introduction: Elder abuse has become a domestic concern in the United States and Canada. Although there are various mandates to report suspicions and incidences in both countries, professionals in dentistry are not identifying and responding at the same rate as the situation is rising. This study has shown that the laws and recommendations have not compelled oral health professionals to action. The reason may be a true lack of education in knowing how to be aware of signs and how to report suspicions, and even ignorance of the scope of consequences to each individual and to society. Discussion: This paper offers the dental practitioner the signs of elder abuse, a review of the legal definitions and mandates and the poor history of reporting within this vulnerable population with the objective to aid in the recognition, awareness, and prevention of elder abuse. Findings: Statistical reviews from national and private research sources reveal a non compliant reporting status in this group, and the problem needs to be addressed through more thorough education and awareness strategies to reach dental healthcare providers in both countries. Conclusions: With initial and continuing education, the oral health professional should become familiar with the problem, and satisfy the obligation to senior patients. Information provided is to enhance existing knowledge on the problem, its prevention, and responsibilities towards victims of elder abuse. When oral health professionals are aware of the prevalence, incidence, and consequences physically and emotionally and the oral health implications, they will be better equipped to help these members of the community.

Introduction: A wide diversity of opinion exists concerning patients with prosthetic joint replacements who should receive antibiotic prophylaxis before undergoing oral procedures. This leads to the perceived need on the part of oral health professionals to contact physicians for advice on management indications. Discussion: There is scarce evidence to support the need for universal prophylactic antibiotics prior to oral procedures in order to prevent infection in a prosthetic joint replacement site. Conclusion: Without reliable clinical studies indicating antibiotic prophylaxis would decrease infection in joint areas, the recent statement published by the American Academy of Orthopedic Surgeons calling for universal antibiotic prophylaxis prior to oral procedures in individuals with a joint replacement should be questioned.

Background: While striving to deliver optimal healthcare, dental hygienists must support their clients’ progression towards health related behavioural changes. An understanding of the theory behind behavioural change can guide dental hygienists in recognizing clients’ barriers to improved oral health practices and offer methods to overcome obstacles. Discussion: Dental hygiene education programs could apply behavioural change theories in clinical assessments. This overview discusses behavioural change theories and models which have been applied in a clinical setting for the purpose of assisting dental hygienists to enhance and support client behaviours. A common theme found in the literature was that in order to successfully improve clients’ long term oral health, dental hygienists must identify barriers that prevent effective daily oral self care regimes. Dental hygienists can establish a respectful collaborative relationship with their clients by recognizing and responding to the clients’ level of readiness for change. This can ultimately result in improvement of their oral health behaviours. Results: The findings included several techniques dental hygienists can utilize to become more proficient in investigating the client’s rationale for non compliance. The techniques focused on using an individualized approach to integrate the clients’ existing beliefs and values into the process of care. Conclusion: Good communication skills and a trusting supportive relationship are the fundamental keys to facilitating the clients’ ability to improve oral health.

Objective: The objective of this paper is to review the evolution and landscape of common types of additives and “functional foods” in the food supply today, and to explore the scientific evidence available to support the value of these many new products to a healthy diet. Discussion: The definition of “food” is complex in today’s world. Advances in technology have allowed the transformation of foods from their natural state to new forms enhanced with vitamins, minerals, and other compounds, usually with the goal of promoting better health. In addition, products traditionally considered “extras” and not basic foods are also being fortified, for example, vitamin water, in an effort to boost their nutrient profiles. These enhanced foods and beverages may appear on the market associated with health benefit claims that may or may not be supported by scientific evidence, and may leave consumers wondering whether they are consuming a food, a drug, or both or neither. Methods: National dietary guidelines, the legal regulations underpinning product marketing and claims, and the peer reviewed literature were reviewed for evidence supporting or not supporting usage and health benefit claims. Results and Conclusion: The number of new food products continues to increase, fueled by consumer interest and demand for healthy products. However, the evidence for actual health benefits for new products can range from strong to nonexistent. Misuse of some can even be harmful. The dental hygienist is an important ally in directing patients to sound and consistent nutrition and health information and should become familiar with the best resources available to assist in this endeavor.

ntroduction Mrs. B, aged 76 years, has come for her 6-month continuing care appointment and you notice that she seems uncharacteristically withdrawn. She gives you one word non committal responses when you ask her how she is, and how she is enjoying the visit from her son and his family. When it is time for her to pay her bill she discovers, apparently for the first time, that the money she thought was in her wallet is not there. She becomes embarrassed and very agitated. You feel worried for her, and wonder what the most appropriate next step might be. Mrs. B’s plight is not as unusual as you might expect. In Canada, it is thought that anywhere from 4 to 10% of older adults will experience some form of abuse during their later years.1 The National Survey on Abuse of the Elderly in Canada: the Ryerson Study, published more than fifteen years ago, is the most comprehensive appraisal in Canada to date of numbers of seniors affected.1 Based on a telephone survey of 2,000 older adults in private homes, the survey established that at least 4 per cent of older adults outside of institutions, that is about 100,000 older Canadians, had experienced some form of harm or ill treatment. These numbers are estimated by researchers and practitioners to be lower than the actual incidence of abuse. It is suspected that there is significant under reporting because many older adults do not, or are prevented from, speaking about the abuse, which also means they are not getting connected with someone who can help. The need for further research is clear in order to determine the extent of the various forms of abuse, associated precursors, risk and protective factors. Abuse of older adults can take many forms, some of which constitute criminal offences. Abuse can be physical, sexual, financial, psychological, or neglect. The Federal Elder Abuse Initiative The Government of Canada launched the first ever Federal Elder Abuse Initiative in 2008 to raise awareness about abuse of older adults.2 They committed $13 million over three years. The four federal government departments implementing the Initiative are: Human Resources and Skills Development Canada (HRSDC), the Public Health Agency of Canada (PHAC), the Royal Canadian Mounted Police (RCMP), and Justice Canada (JC). Together these ministries and agencies have: created and aired television a • ds to raise awareness, • begun implementation of a national research agenda (including laying the preparatory definitional groundwork, should a national prevalence study soon be possible), • made funds available to regional organizations to raise awareness, build or strengthen local networks and exchange knowledge, and • developed many tools to assist health care providers and other responders in addressing and preventing abuse of older adults. In addition, national professional associations, seen as having a central role to play in educating their members, led to the announcement of funding to do just that. The Canadian Dental Hygienists Association (CDHA) was one of the successful applicants. Implementation of this exciting two year project has just commenced. CDHA joins the Canadian Nurses Association, the Canadian Association of Occupational Therapists, la Fédération des associations de jurists d’expression française, la Fédération des locataires d’habitations à loyer modique du Québec, and the Fondation du Centre de santé et de services sociaux de la Vieille-Capitale in developing professional education for members. The dental hygienist’s role The Federal Elder Abuse Initiative and the funding it provides to professional associations affords the opportunity to raise awareness of this issue. CDHA members have an increased opportunity to interact and build relationships with older adults due to changes in and the expansion of practice settings resulting from legislative reform (collective or facility care, public health settings, and mobile or private home based practices). Combined with the fact that Canadian demographic projections reflect a growing aging population, the time for dental hygienists to take proactive and substantive action has arrived. Health Canada predicts that by 2026 every fifth Canadian will be over 65; seniors are the fastest growing population group; and the number of oldest seniors is the most numerous within the senior group.3 There is a level of trust that comes with the designation of “registered dental hygienist”. Clients confide in their dental hygienists, who are recognized as caring oral health professionals, and who may be among the few people with whom the older adult has any contact. Further, there is potential for long term relationships that enable changes in a person’s presentation, general hygiene, and emotional tone to be noticed and considered. 16 2011; 45, no.1 e d i t o r i a l CDHA’s role The CDHA is utilizing its existing approach on delivery models expanding professional response to produce an online course on recognizing and responding to elder abuse. The course consists of four online modules, supported by a resource manual, chair-side educational resource and wallet card, and a series of webinars. Overall, the course includes an overview of the issue and dynamics of abuse, factors that raise and mitigate risks, possible effective responses, and case scenarios. The delivery models focus on the select fraternity of CDHA members, as well as practising dental hygienists and dental hygiene students across Canada. The online course will be launched in the first quarter of 2011 with three follow up webinars in March, April, and November 2011, focussing on typical client cases and practical approaches. A session highlighting the course will also take place at the annual CDHA Conference in Halifax in June 2011. What dental hygienists can do about abuse of older adults CDHA ’s professional development initiative on abuse of older adults will result in resources and support tools to empower dental hygienists to take necessary action where abuse of an older adult is suspected. Background information about causes and signs of abuse, and how to intervene safely will be presented in the online course, chair-side resources, and the webinars. C ase studies will be offered to provide scenarios and suggestions of ways of dealing with the situation. CDHA members will be much better informed on what to do. F or example, in the case of Mrs. B, a dental hygienist might: • Note that Mrs. B seems upset and agitated • Gently ask Mrs. B if she would like to talk more about what is going on • Listen to and believe Mrs. B’s perspective • Ask Mrs. B how she would like to be supported and let her know that she is not alone and that there are people who can assist • Check what the policies and procedures are in the work place when such a situation arises • Let the supervisor know about the situation if Mrs. B is living in a care facility Conclusion CDHA welcomes this opportunity to be part of the Federal Elder Abuse Initiative activities, and to inform and support members to enhance their role with older Canadian adults. Dental hygienists are well positioned to be “eyes and ears” to detect possible abuse situations and to advocate for and help with practical solutions for their clients. Together we can make a difference in combating the issue of abuse of older adults. References Podnieks, E. National Survey on Abuse of 1. the Elderly in Canada. Journal of Elder Abuse & Neglect. 1992;41(1/2):5–58. 2. Human Resources and Skills Development Canada. Federal Elder Abuse Initiative Funding. [Cited 2010, Nov. 6] http://www .hrsdc.gc.ca/eng/community_partnerships/seniors/nhsp/feai/ ap/2009_2010.shtml 3. Government of Canada. Canada’s Aging Population. Ottawa. Queen’s Printer for Canada, 2002.

Background: Daily oral biofilm disruption is necessary for periodontal health; however, clients’ dental flossing compliance is low. This study explores the interdental brush for bleeding and plaque reduction in sites of intact interdental papillae. Methods: Examiner blinded, randomized, split mouth, 12 week clinical trial comparing interdental brush (n = 224 sites) to dental floss (n = 223 sites) for bleeding and plaque reduction in thirty volunteers with a minimum of 4 bleeding sites per side. Non surgical debridement performed at Week 2 with oral hygiene instructions at Weeks 0 and 6. Bleeding and plaque indices at Weeks 0, 6, and 12. Results: One way ANOVA comparing interdental brush mean bleeding sites 1.08 (SD 0.27, CI 1.04 to 1.12) to dental floss sites, mean 1.19 (SD 0.39, CI 1.14 to 1.25), demonstrated statistical significance, p = 0.01. There was no statistical difference between interdental brush mean 5.14 (SD 2.62, CI 4.80 to 5.49) and dental floss mean of 5.12 (SD 2.51, CI 4.79 to 5.45) for plaque sites, p = 0.93. Post hoc analyses at the subject level, interdental brush mean bleeding was 0.08 (SD 0.02, CI 0.07 to 0.09) and dental floss mean was 0.2 (SD 0.04, CI 0.18 to 0.21) at Week 12, p = 0.01. Conclusion: Interdental brush significantly reduces bleeding sites in subjects with Type I embrasures. Both interdental aids significantly reduced plaque over 12 weeks.

Introduction: Interprofessional education (IPE) is defined as occasions when two or more professions learn about, from, and with each other to improve collaboration and the quality of care. Nursing and dental hygiene students at George Brown College were brought together in an IPE initiative to learn about, from, and with each other in regards to the overlapping roles they share in oral health and blood pressure monitoring. The World Health Organization (WHO) has long advocated for “multiprofessional” education among undergraduate healthcare students to build “the skills necessary for solving the priority health problems of individuals and communities that are known to be particularly amenable to team-work”. Discussion: The discussion will present developments the Ministry of Health and Long Term Care (MOHLTC ) in Ontario, Health Force Ontario, the Registered Nurses Association of Ontario (RNAO) and the Office of the Chief Dental Officer (OCDO) are making to improve collaboration and quality of care within healthcare. The new National Competencies for Dental Hygiene also advocates such collaborative practices. Findings: There is evidence of the connection between oral health and systemic health, and the increased need for proper daily oral health assessment and care for populations within acute and long term care. At present, members of the nursing profession whose scope of practice includes providing oral assessment and daily oral care are the front line caregivers for these populations. The increase in high blood pressure within the general population is also a priority health problem. Dental hygienists are front line health professionals in oral assessment and oral care education whose scope of practice includes taking blood pressure and pulse. Conclusions: The results of the Canadian Health Measures Survey (CHMS) show that approximately 70 per cent of the population sees an oral health practitioner on an annual basis. Dental hygienists are in an ideal position to monitor and screen for high blood pressure. This paper reports the lessons learned from the IPE initiative, rationales for continuing this initiative, and the future directions of this initiative in fulfilling aspects of the proposal by George Brown College (GBC) to implement IPE initiatives

Background: The objective of this scoping review is to examine the existing science on the relationship between periodontal disease and adverse pregnancy outcomes. Confirmation of periodontal disease as a risk factor for adverse pregnancy outcomes would be a huge public health benefit because periodontal disease is both treatable and preventable. Methods: A search was conducted in the Cochrane, Medline, CINAHL, EMBASE, PUBMED, and BioMed Central online databases. Of the 72 papers identified, 9 systematic reviews and meta analyses were included in the review. Findings: Some studies have reported an association between periodontal disease and adverse pregnancy outcomes. However, heterogeneity among studies in definitions of periodontal disease and adverse pregnancy outcomes, inadequate control for known risk factors and confounders, small sample size, and unclear study design strongly influence the validity of the findings. To date, there is no evidence to support providing periodontal treatment during pregnancy to reduce the occurrence of an adverse pregnancy outcome. Since association does not indicate causation we recommend that larger, methodologically rigorous studies using universally accepted definitions be undertaken. Conclusion: Dental hygienists should encourage their pregnant clients to seek non surgical periodontal treatment, especially during the second trimester, because it has been shown to be safe and effective in reducing the signs of maternal periodontal disease.

Background: Research has shown that mentees can benefit both personally and professionally from involvement in mentee–mentor relationships. Although mentoring has been explored extensively, there is a gap in the research from a dental hygiene perspective. Objectives: The aim of this review is to examine literature related to answering the question: Could involvement in a mentee-mentor relationship facilitate the transition from student to practising dental hygienist for dental hygiene students or recent graduates? This paper examines the concept of mentoring; defines relevant terms; and explores the benefits, challenges and features of mentoring relationships. Current research and its relevance to the dental hygiene profession are discussed. Method: Using key words and combinations of keywords, an electronic search of standard databases was conducted. Authors reviewed primary, secondary, and professional sources of literature. Results and discussion: Individual studies and the overall body of research show limitations. Evidence suggests that although successful mentoring frequently yields beneficial outcomes for novices, not all mentoring relationships are positive; mentees and mentors must work collaboratively; and challenges for mentoring programs need to be identified and overcome. Conclusion: While individual studies do not adequately answer the question, collectively they suggest that mentoring relationships can ease the transition from student to practitioner. Mentoring programs would benefit from implementing structured evaluations of processes and outcomes to ensure that they are effective and beneficial. More dental hygiene specific primary research on this topic is required to fully understand the role mentorship plays in the transition to clinical dental hygiene practice.

Background: It is important for healthcare providers, including dental hygienists, to appropriately base practice on current evidence to improve health outcomes. Transferring knowledge from the research environment to practice falls within the broad research field referred to as knowledge translation. Various enhancers and barriers to using current evidence in practice have been reported on, but cross discipline investigations have largely been absent from the literature. The purpose of this paper is to present the findings of a qualitative study that explored and compared dental hygienists’ understanding and experiences with evidence based practice (EBP) to those of nurses and psychiatrists. Methods: Researchers conducted individual interviews with dental hygienists, nurses and psychiatrists using a general interview guide that included a discipline specific scenario designed to investigate clinicians’ experiences implementing EBP. Because of the exploratory nature of the study, saturation of data was not attempted. Guided by a grounded theory approach, researchers used thematic analysis to determine the enhancers and barriers to EBP and compared major themes across the professions. Results: The majority of participants, including dental hygienists, demonstrated an understanding of EBP and identified enhancers and barriers to implementing EBP. Several major themes acting as enhancers and barriers to EBP emerged and revealed both differences and similarities between the dental hygienists and the other disciplines. Discussion and Conclusion: While exploratory, this research is important in understanding the role of the practice milieu in relation to individual practitioner characteristics in implementing evidence into practice. While dental hygienists encountered unique structural challenges in implementing EBP, they also reported difficulties similar to the other disciplines, particularly nursing. The study’s findings were important in directing dental hygiene research providing a departure point for a large multi phase study currently underway specifically examining structural influences on dental hygiene decision making and practice change.

Though much has been done to discourage tobacco use through education, programs, policy, and law, people continue to use this toxic substance with known carcinogens— often leading to disease or even death.1 According to the Canadian Tobacco Use Monitoring Survey (CTUMS) 2009 half-year results,2 17% of Canadians 15 years or older (approximately 4.8 million) reported currently smoking. In the US, an estimated 20.2% (or 46 million) of Americans 18 years or older smoked.3 Overall, smoking prevalence has not changed from the previous year in either country. One could ask—why not? Tobacco use often leads to a chemical dependence and the establishment of behavioural patterns leading to an addiction or habit that can be very difficult to stop.4 What we know about tobacco related oral health issues Over the past sixty years, research has clearly demonstrated that the use of both smoked and, to a lesser degree, smokeless tobacco can lead to disabling disease or even death.1 Even those smoking 1–4 cigarettes a day, light smokers or “chippers” have been shown to have a significantly higher risk of dying from heart disease than non smokers.5 In addition, profound oral health risks are associated with smoked tobacco including oral cancer, precancerous lesions6, periodontal disease7,8 increase in tooth loss, and implant failure6,9 Smokeless tobacco use, though not containing many of the 4,000 harmful chemicals found in tobacco smoke, can lead to precancerous lesions, dental caries and gingival recession.6 In recent years researchers have explored the harmful oral effects of being exposed to passive smoking also called second hand or environmental smoke (ETS) on children. Erdemire et al.10 reported children exposed to ETS were found to have an elevated level of cotinine, a major metabolite of nicotine. Periodontally, these children had a lower clinical attachment level than children not exposed to tobacco smoke.10 Another study11 showed an increase in the incidence of dental caries to be significant in 5 year olds. Interestingly, “even after adjustment for parental educational level, dietary and oral hygiene habits, a more than threefold elevated risk for caries associated with parental smoking was revealed in 5-year olds.”11p.255 Evidence is mounting that children are profoundly affected by exposure to ETS resulting in both general and oral health problems. Tobacco cessation counselling in dental hygiene As oral health professionals committed to health promotion and disease prevention, it may be time to take a step back and explore the concept of tobacco cessation counselling (TCC) and what it means. The often repeated US Public Health Service (PHS) Treating Tobacco Use and Dependence 2008 Update’s12 five As (Ask, Advise, Assess, Assist, Arrange) or brief intervention counselling13 (BIC—Ask, Advise, Assist, Arrange) are considered a brief editorial intervention taking 3–5 minutes. A similar model is the Ask, Advise and Refer from the American Dental Hygiene Association where the tobacco using client is encouraged to quit then given “quit information”.14 At the heart of these models is to identify tobacco use then educate the client on the benefits of quitting. The PHS Guideline12 reports those who receive even a brief tobacco intervention have a significant increase in reaching and maintaining long term abstinence. The Guideline12 goes on to stress the likelihood of long term abstinence is even greater with counselling and medications. In 2004, Canadian Dental Hygienists Association published The Tobacco Use Cessation Services and the Role of the Dental Hygienist – CDHA position paper15p.1 where, among several recommendations, stated: “Dental hygienists can change clinical culture and clinical practice patterns so that every client who uses tobacco is identified and offered at least brief counselling”. The spirit of motivational interviewing While there may be many opinions as to what exactly entails effective tobacco cessation counselling, the intervention often involves more than imparting knowledge or education alone. Health education can be effective in motivating some to make a change in their health behaviour, but in others, it may cause resistance resulting in the classic response “Yes, but…”. When asked, healthcare providers often report client resistance as a barrier to offering tobacco use counselling. Could it be that at least some of the problem lies with the clinician rather than the client? Of PHS’s five As, the first three12—Asking, Advising and Assessing—could be offered in two ways. To illustrate the direct educational way: I see that you smoke. Your oral health is at risk and you really need to quit smoking in order to save your teeth. The second way would be supportive, empathetic: I see that you smoke, would it be OK if we talked a little more about it? Advice would follow after a collaborative dialogue has been started. Which method would elicit defensiveness, and which would make a client feel at ease? The theory of Motivational Interviewing (MI) has been extensively utilized in both clinical settings and research protocol. Psychologists first used this counselling technique to treat alcoholism.16 MI has been advocated as an effective client centred tool for healthcare providers when treating behaviourally based chronic diseases,17–19 and encouraging good oral care.20 Over thirty years of articles, books, and reports available on MI indicate significant improvement in patients’ smoking behaviour.12,21–23 According to Miller and Rose,21 MI emphasizes two main components: 1) a relational component where empathy and interpersonal elements are used, and 2) a technical component where patients are encouraged to share their thoughts, preferences and ambivalence, allowing the clinician to move the conversation in a positive, health changing direction. Emmons and Miller19p.70 state, “Readiness to change is not a client trait but a fluctuating product of interpersonal interactions”, contending that clients do not stay in a static stage as described in the stages of change (precontemplation, contemplation, preparation, action maintenance).24 The active interaction of eliciting, reflection, examining discrepancies then resolving them may move a client from precontemplation to preparation stage in just a few minutes. At the heart of MI is establishing a rapport and building a relationship of trust between clinician and client where the client is in control of his or her own health. This is especially important between oral health providers and their clients who seek dental care on an annual or semi annual basis over many years. If a client perceives a clinician as judgmental, policing bad behaviour, or another tobacco lecture, the client may immediately disregard the advice, or even change providers. MI is considered a brief psychotherapy, and has numerous aspects and skill sets to learn. Though some of the basic concepts are not difficult, MI takes time, self awareness, and practice to gain mastery. In response to the time Collaborative Partnership between patient and clinician, dancing rather than wrestling Evocative Elicit or bring out the patient’s own motivation and resources for change Honoring patient autonomy Recognize it is the patient who makes their own decisions – the power is in their hands, the clinician cannot change anyone Table 3. Motivational Interviewing resources. Table 2. The Four Guiding Principles of Motivational Interviewing: RULE. Adapted from Rollnick S, Miller WR, Butler CC. Motivational Interviewing in Healthcare: Helping Patients Change Behavior. 2008;8–10. Table 1. The Spirit of Motivational Interviewing. Adapted from Rollnick S, Miller WR, Butler CC. Motivational Interviewing in Healthcare: Helping Patients Change Behavior. 2008;6–7. Motivational Interviewing Org. www.motivationalinterview.org Motivational Interviewing in Healthcare: Helping Patients Change Behavior (2008) by S. Rollnick, W. Miller and C. Butler. New York: Gilford Press. www.gilford.com Motivational Interviewing: Preparing People for Change (1991) by W. Miller and S. Rollnick. New York: Guilford Press. www.gilford.com Building Motivational Interviewing Skills: A Practitioner Workbook (2009) by D. Rosengren. New York: Gilford Press. www.gilford.com R: Resist the Righting Reflex Resist the inner need to make things right, correct, often by education U: Understand Your Patient’s Motivation It is the patient’s own motivations (not ours) that are likely to trigger behaviour change L: Listen to Your Patient Listen at least as much as informing – often the answer lies within the patient E: Empower Your Patient Help patients explore how they can make difference in their own health constraints involved in client care, brief adaptations of MI requiring from 5 to 30 minute interventions have been introduced.19 Rollnick et al.25 provide a practical approach to helping people change unhealthy behaviours without alienating them—within the time allotted for client care.25 The authors offer a rich array of concepts, frameworks, and vignettes that clinicians can learn and practise on their own.25 The “spirit” of MI is described as collaborative, evocative and honoring of client autonomy (Table 1). The client is viewed as an equal partner in the individual’s health care, working out issues and making positive changes with the clinician acting as facilitator in the process. The guiding principles of MI are: resist, understand, listen, and empower (Table 2). Again, the clinician must relinquish the role of “authority and educator” and resist the urge to correct, or fix the “unmotivated or unknowledgeable” person.25 Rather, by taking the stance of listening and understanding the client’s motivation or reasons for change or not changing, the clinician can empower or give control back of the client.25 For example: You have five caries. You need to cut down on your sugar intake and brush your teeth more effectively. Or, I’m concerned that you have five caries this visit. Can you tell me about what you think may be happening here? (Pause, listen) The first is accurate but authoritative, in one direction and almost certain to evoke defensiveness or rebuttal. The second educates, shows empathy, and provides an opportunity for self reflection, assessment, and client empowerment to direct the discussion. For resources on health behaviour change, see Table 3. Conclusion How can we be effective in helping our tobacco using clients quit? Addressing this behaviourally based chronic, relapsing disease from a client centred approach, clinicians can establish rapport and trust. This will empower and support clients as they make positive health choices in both the short and long term. As clinicians, we have the ability and opportunity to learn these proven techniques and skills that will help not only our tobacco cessation efforts, but all of our client interventions, breaking the cycle of chronic relapsing disease.

Background: Effective program evaluation is key to the improvement of dental public health programs. Employing an appropriate evaluation design is crucial to ensuring the results are of relevance and value to program decision makers. This paper describes the importance and the application of an Evaluability Assessment (EA) in the determination of a feasible evaluation design for a dental prenatal public health program in Vancouver, British Columbia. Methods: The program’s dental hygienist adopted the role of inside evaluator and collected data for the EA by semi structured interviews, retrospective chart reviews, field observations, and a review of appointment statistics. Results: The EA developed and refined the program’s goals and objectives; generated a list of stakeholders and their roles and responsibilities; and produced a Logic Model that explained the theory of the program. The process of the EA revealed discrepancies between the program’s reality and its intent, but details of the program’s organizational structure and funding sources were clarified. Existing record keeping methods were found to be less than ideal for the purposes of an evaluation; however, the organizational climate was supportive of further program evaluation. Discussion: The EA clarified the program’s goals and the stakeholders’ roles and responsibilities and, in the process, enhanced overall interest and awareness of the program. Conclusions: The EA determined that a process evaluation was a feasible design to improve the program’s operations, but that an evaluation of outcomes would be challenging. Conducting an EA is an important preliminary stage in the preparation of a feasible and meaningful design for the evaluation of a dental public health program

Interdisciplinary collaboration has been advocated in health care for many years, and more recently, has focused on the inclusion of oral health care. This paper illustrates a successful collaboration between nursing and dental hygiene; it carries the potential to change nursing practice and advance oral hygiene care across Ontario, Canada, and internationally. In addition, the paper outlines an ongoing collaboration— an oral health community of practice (CoP) that serves as an example of the synergy created when professionals work together towards a common goal.

There is little published literature pertaining to motivating influences, experiences, and outcomes of baccalaureate degree education in dental hygiene. Since there are various dental hygiene educational models in Canada, exploring the advancement of dental hygiene education is becoming an increasingly important subject. The purpose of this study was to explore the motivating influences for and experiences in dental hygiene baccalaureate degree-completion education in Canada, from the perspectives of diploma dental hygienists who had continued their education to the bachelor’s degree level. This study employed a qualitative phenomenological design, using a maximum variation purposeful sampling strategy. Data generation occurred with sixteen dental hygienists across Canada through individual semi structured interviews. Interviews were audio recorded, transcribed verbatim, and coded for data analysis, involving pattern recognition and thematic development. Emerging themes regarding motivating influences included: expanding career opportunities in dental hygiene, personal development and a desire for knowledge, remaining competitive, status and recognition, access to graduate education, and third person influences. Participants’ experiences in degree completion programs included obtaining a broader education and being exposed to a wider scope of knowledge within and outside of dental hygiene theory. They also experienced a more independent learning environment, with a stronger focus on literature review and critical thinking, compared to their experiences in their dental hygiene diploma education. These results reveal important insights for those dental hygienists who may be considering additional dental hygiene education.

Background: Recent attention being paid to the oral–systemic disease paradigm has focused not only on the potential systemic complications linked to oral inflammation and infection but also to the oral manifestations of systemic disease. One such group of systemic illnesses is that of a psychiatric nature; diseases which affect with significant impairment, an individual’s emotional, behavioural, and social relationships. This paper will endeavour to enhance the self efficacy and knowledge of the practising dental hygienist through a review of one particular psychiatric diagnosis, eating disorders. This paper will focus on current theories of causation, medical and clinical oral manifestations, and preventive dental strategies. Methodology: A literature search was conducted using several data bases: Medline, CINHAL, and Psychological abstracts. The search terms included anorexia nervosa, bulimia nervosa, oral management of eating disorders, and erosion. The great majority of the articles retrieved from these databases consisted of case reports and peer reviewed literature reviews. Results and discussion: Eating disorders comprise one of the more common psychiatric diagnoses, and have been further subdivided into anorexia nervosa, bulimia nervosa, and binge eating disorder. These subtypes are closely linked, often inter-related, and form the majority of eating disorders. Both knowledge and awareness of this illness is important for the dental hygienist. In many cases, they may often be the first individuals to recognize some of the characteristic oral manifestations. And in conjunction with the dentist, they may engage in secondary preventive practices through the initiation of dialogue and referral processes to facilitate the patient obtaining appropriate medical care. Conclusion: As common as mental illness is in our society today, patients with eating disorders will often go unrecognized, be misunderstood, or receive inadequate treatment due to the attitudes arising from the stigma associated with this illness. Dental management considerations in turn present a significant challenge to the oral health professional. Eating disorders continue to represent a serious and, often fatal, threat to an individual — a threat which can be preventable through earlier recognition, referral, and treatment.

In the scientific community, peer review is a common and necessary process that authors go through in order to get manuscripts published. Peer review makes an important contribution to the quality of a journal and, by extension, to the professional organization that produces that journal. Generally speaking, peer review is a process whereby one or two “peers” or experts in the field, scrutinize a manuscript submitted for publication and provide comments to the journal’s editor regarding the academic quality and scientific rigor of the paper. It involves judgment of the merits of the research question, the methods used to address it, and the interpretation of the results based on the data collected.1–3 This process provides editors, authors, and readers alike with an assurance that the publication is reporting relevant findings, warranted claims and supported interpretation of the results.4 This assurance is important and serves as a filter for readers, given the avalanche of materials available from multiple sources in this information age.5 Peer review also supports decision making by editors regarding what to include or not include in a journal, as structured rigorous review processes lend objectivity to editorial decisions.4,5 The peer review process has also been studied and found to make measureable and substantive improvements to the quality of articles.2 While all components of articles in the study were improved by peer review, manuscripts weak in certain areas were more greatly improved by this process than those that were already good when submitted.2 Those who participate in peer review also benefit from this process. They may broaden their knowledge of a topic area, and develop or enhance their skills in scientific criticism. 4 The ongoing development of these skills contributes to continuing competency, an important attribute of a profession, and a responsibility of all of its members. Peer review also contributes to career rewards and recognitions, both for the individuals being reviewed and those providing it.6 Faculty members of universities and colleges receive greater recognition for works that appear in peer reviewed journals.3,6 Articles found in peer reviewed publications are more likely to be identified during electronic literature searches and subsequently cited by other authors, which in turn helps develop an author’s standing in the field.3 Those who volunteer as peer reviewers can also benefit from such career rewards as being recognized for their contribution of service to the profession, and receiving credit for continuing competency activity. Through exposure to different writing styles as well as writing shortcomings, peer reviewers also learn how to improve their own work. Peer review aims to improve the quality of a manuscript as previously discussed, but can only do so in terms of the writing and reporting of a study. Reviewers give direction to the author to ensure the information in the manuscript is valid and well written, which then gives the reader assurance that the information presented is credible. From there the readers can draw their own conclusions. However, peer Editorial review cannot correct or compensate for fundamental flaws in the methodology of a study or a weak research question.2 If peer reviewers identify poorly constructed studies, they can then make recommendations to editors against publication.6 Dental hygiene continues to evolve as a profession, and implicit in this evolution is the continuing development of the Canadian Journal of Dental Hygiene (CJDH), the Canadian Dental Hygienists Association’s (CDHA) professional publication, that was first published in 1967 under the title, Canadian Dental Hygienists Association Journal. The journal has changed and developed over the years, and CDHA now publishes six issues a year to update the profession on a variety of issues including scientific articles related to oral health. Incorporating peer review as part of the publication process has helped improve the quality of the publications and reflects favourably on the Association and the profession. There is however, no standard format for development of peer reviewer skills. Most peer reviewers learn their skills through experience or by reading articles about it although these are not plentiful. We are suggesting that CJDH implement a professional development opportunity for dental hygienists to learn peer review skills by “shadowing” experienced peer reviewers. This process would be in addition to the standard peer review processes already in place at CJDH. When a manuscript is received by the Scientific Editor and assigned to the formal peer reviewers, it would also be assigned to a ‘shadow’ peer reviewer. All reviewers would assess the manuscript and provide the Scientific Editor feedback. After the peer review process is complete, the Scientific Editor would provide copies of the formal peer reviews to the ‘shadow’ reviewer, along with suggestions for development, if any. Development of a shadow review process would require permission from authors to share their submitted manuscripts, and for formal reviewers to share their comments with the shadow reviewers. Shadow reviewers would also have to adhere to the same ethical obligations as the peer reviewers to honour confidentiality. Resources for development of peer review skills would be provided in advance to prepare shadow reviewers; a list can be found at the end of this editorial. A letter of confirmation of participation in the peer review process could be provided for inclusion with continuing competency documentation. We could not locate published materials on the use of shadowing to develop peer review skills, but we are aware anecdotally that this has occurred at other journals. We suggest that this would also be a useful activity for graduate students as they learn how to write manuscripts to publish their own research. CDHA’s Milestones in Dental Hygiene Research in Canada document points to the need and the opportunities for increasing dental hygiene’s research capacity in Canada.7 We suggest that increasing our cadre of peer reviewers through implementing a shadow peer reviewer development program will contribute to increasing our research capacity by helping develop quality writing skills as the reviewers’ skills develop. We encourage the CJDH to demonstrate leadership among health professional journals by actively developing and promoting a shadow peer review program. Subsequent evaluation of such a program would make a valuable contribution to the literature on professional development. This would also contribute to the continuing advancement of dental hygiene in Canada.

Gingivitis is often diagnosed by the presence of gingival bleeding with or without other signs of inflammations such as changes in tissue colour, contour, and consistency. Gingivitis remains a prevalent oral disease among institutionalized elders. Many indices have been developed to aid examiners in the identification and quantification of gingivitis. However these indices might not be suitable for use due to compromised operator positioning and poor lighting with frail elders, particularly those who are institutionalized. Frail elders living in institutions are often medically compromised, may require antibiotic prophylaxis for probing, and may have a limited tolerance for lengthy examinations. For these reasons the authors propose the use of a new gingivitis index that does not elicit bleeding and uses a dichotomous visual assessment. The Gingival Inflammation Index for Frail Elders (GIIFE) is minimally invasive, does not require antibiotic prophylaxis, and is easy for an operator to perform and client to tolerate. This index has been found to be as effective as the Gingival Bleeding Index in identifying gingivitis, with the benefit of not causing discomfort or difficulty for either the examiner or client. On further testing, it is expected that this new index will provide a more practical method of identifying and assessing gingival inflammation within this population.

Native Americans comprise a particularly vulnerable group with low rates of access to care and high rates of unmet dental needs.1 Additionally, Tribal members often comprise a low percentage of the total population, so are not clearly identified as an ethnic group in state or national oral health surveys. Health professionals have a social and ethical responsibility to provide effective services in health care systems that are challenged with disparities.2 Public health professionals strive to address these disparities using the core public health functions, assessment, assurance, and policy.3 These core functions address health disparities because assessment defines the health disparities and determines overall program effectiveness, assurance addresses appropriate services, and policies serve to institutionalize successful practices. In this case study, oral health assessment was accomplished through community surveillance. Using the surveillance information, Tribal health staff was able to follow up high risk individuals to ensure appropriate care was given. This surveillance information was also used to refine policies regarding preventive service frequency and reimbursable procedures. Without regular surveillance it is difficult for the Tribe to determine if members are getting appropriate services, and if current policies are beneficial. The Jena Band of Choctaw Indians is a federally recognized tribe with a majority of members residing in a three-parish area of east central Louisiana including Grant, LaSalle, and Rapides parishes in the USA. The Tribe has 189 members who reside in the service area, and are therefore eligible for oral care services provided by the Tribe. The Tribal members living within the service area belong to these ranges of age: 0–18 years=81 members; 19–54 years=114 members; 55–62 years=11 members, and 63–85 years=2 members. The service area is rural, but these Tribal members have been able to receive dental care in local private practice dental offices. Because of the Tribe’s size, few direct services are delivered on site. Most of the medical and dental services are funded through the Tribe’s Contract Health Services (CHS) to local private practitioners. This is an efficient means of providing health care for Tribal members because the Tribe does not maintain medical and dental facilities nor employ health professionals. However using CHS only creates a unique challenge for the Tribe. The Tribe can determine the number of visits that have been paid through CHS but because the Tribe does not maintain a health record for most services, it is difficult to track health status, determine Tribal member’s health needs, or identify Tribal members at high risk for targeted services. The Tribal Health Department has set a goal to monitor annually the health status of eligible Tribal members. The Tribe tracked several health indicators at the community events including hypertension, blood glucose, glaucoma, and immunizations; the results of those indicators are not included in this case report. The purpose of this case study is to describe planning and conducting a community health fair for the purpose of monitoring oral health indicators.

Background: Toothbrushing for daily oral biofilm disruption is well accepted by clients, but dental flossing is not, due to poor dexterity or lack of motivation or both. The interdental brush is considered an easy to use alternative, which may influence daily self care compliance; however it has only been studied in subjects with open embrasures. Purpose: To determine whether interdental brush’s ease of use influences willingness for daily compliance in subjects with intact interdental papillae. Methods: This paper focuses on the secondary outcome of a randomized controlled trial comparing interdental brush to dental floss in 32 adults with intact but bleeding interdental papillae. Subjects received non surgical debridement two weeks prior to intervention phase, and instructions to use toothbrush, dental floss, and interdental brush at baseline (week 0) and week 6. Subject compliance was measured with self reported journals and amount of products used. Exit survey collected information about subjects’ perceptions and preferences for interdental brush and dental floss. Results: Subjects were more than twice as likely to “strongly agree” that interdental brush was easy to use compared to flossing, with 40% having neutral opinions about dental floss’s ease of use. They were also willing to use the interdental brush daily (43.3% strongly agreed and 50% agreed). The subjects’ opinions regarding daily dental flossing ranged from “disagree” to “strongly agree” (6.7% to 30.0% respectively). Discussion: Study results were similar to other studies that demonstrated client compliance with interproximal oral self care is associated with clients’ perceptions of ease of use and motivation. Conclusion: Interdental brush is easy to use and well accepted by study subjects, which may positively influence daily interproximal self care compliance.

Measuring client satisfaction is essential for all health care providers. This importance is reflected by an emphasis on client approval, motivated in part by the interests of the client as consumer, and as an independent health care end result. Evaluation of client satisfaction using a variety of data collection, self assessment, and communication techniques, is included in dental hygiene practice standards as a significant oral care outcome.1 The delivery of high quality preventive oral care has always been the goal of the dental hygiene profession.2 Implementing formal quality assurance programs is one way that the profession has encouraged this value. Self assessment is a key component of quality assurance and can be applied to the delivery of dental hygiene care in private, community, and educational settings. Quality assessment criteria relative to private practice are of particular concern to the profession because most dental hygienists are employed in somewhat isolated settings and practice without the benefit of peer review. Self assessment can be simply described as the process of gathering and evaluating data on one’s own actions. The four major uses of self assessment are: evaluate performance, identify learning needs, improve performance, and reinforce cognitive abilities and skills. As primary oral health care providers and professionals, dental hygienists are accountable for regular review of their knowledge, skills, and judgment. Studies indicate that the acquisition of self assessment skills can promote mature, productive, and collaborative environments.2 Reflective practice How can dental hygienists develop these self assessment skills? Certainly, dental hygienists do informally compare their own clinical actions to professional standards each day, but may lack the specific outcome measurements they use when evaluating therapy results. Reflection has been defined as an internal process that individuals use to help refine their understanding of situations, and that may lead to changes in their perspectives.3 Reflection is particularly important for health care providers where evidence based practice and client centred care require the practitioner to analyze scientific evidence while also considering the values, beliefs, and goals of each client. Being reflective practitioners will assist dental hygienists maintain the attitude necessary to their professional role. Silence versus satisfaction Consumers of oral health care have traditionally been unable to evaluate objectively the quality of care they receive.2 Although their feedback is valued, the fact is that most clients hesitate to make negative remarks. Health care is composed of two primary elements—the technical adequacy of therapy, and the art or manner of care. Depending on their perspective, clients tend to perceive “good” practitioners as either kind or technically capable. Client satisfaction or dissatisfaction is a complex issue linked to expectations, health status, and personal characteristics. What is perceived as merely acceptable care by one person may be an exceptional experience to another while unacceptable to a third.4 Clients commonly object to mechanical or impersonal care, so rather than limiting evaluations to technical skills, dental hygienists do need to address the broader aspects of quality assurance.5 For example, clients with low self esteem or perceived lesser status may hesitate to offer comments. At the same time such behavioural indicators as high no-show rates could indicate less satisfaction with the care they have received. It is important that the voices of clients are heard. One of the simplest quantitative evaluation techniques for client feedback is the use of comment cards. While this method does not yield statistically valid data, it can produce an understanding of clients’ overall experience. For example, if the card responses indicate a recurring problem, attention can be directed to correcting this situation. On the other hand, positive remarks can reinforce many exceptional aspects of the care provided. Brief personal interviews, using a standardized script, can also be conducted to determine clients’ perceptions of their care. This informal dialogue could be accomplished onsite by the practitioner or office manager at little or no cost. Finally, by working together as a unit, the members of the dental care team can convey both confidence and competence to their clients.6 Clients are more satisfied when they are cared for by professionals who are part of a cohesive team that shares values, ideas and a clear sense of mission.

Osteonecrosis of the jaw has recently been reported as a possible adverse drug effect from bisphosphonate therapy. The reports are worldwide and the morbidity for the condition is significant. The exact mechanism of action of bisphosphonate effects leading to osteonecrosis of the jaw is unclear but research is identifying hypotheses of anti angiogenic effects, and that bisphosphonate causes soft tissue toxicity resulting in poor wound healing of mucosa, thereby promoting infection of associated underlying bone. Most bisphosphonate associated ONJ cases developed following oral surgical procedures, but some cases develop spontaneously, unassociated with dental treatment. Clinical practice guidelines for management of care have recently been published by a Canadian task force organized by the Canadian Association of Oral and Maxillofacial Surgeons, and in the United States, by an expert panel invited by the American Dental Association.

Optimum oral health should be the focal point of dental hygiene practice. This case report presents discussion of a client case from the George Brown College dental hygiene clinical program. This client presented with moderate to severe non carious tooth surface lesions. The non carious tooth surface lesions were related to various factors that were a result of past and current etiologies including attrition, abrasion, erosion, and abfraction. The conclusion of this case discussion is that the etiology of non carious tooth surface lesions is multifactorial. In order to manage tooth wear and reduce further risk, it is imperative that the dental hygienist perform comprehensive assessments and dental hygiene diagnoses encompassing the goal of optimum oral health.

In recent decades interest in advocating for change in health policy has been growing among health professionals. National and international agencies and researchers identify health professionals as advocates for influencing those in power to increase accessibility and reduce health disparities. Health care reform movements and health care restructuring have stimulated a renewed interest in the need for policy advocacy by professions. Disparities in health and in oral health together with growing inequities in access to health care and to oral health care for many populations demonstrate the need for political action and social change. Advocacy education in nursing has been shown to be effective in creating nursing graduates who are interested and willing to participate in political action initiatives for social change. Dental researchers acknowledge that involvement in advocating for change in oral health policy and service accessibility is a profession’s moral responsibility. Dental hygiene educators are beginning to explore and develop curriculum to prepare dental hygienists with the skills and knowledge required for political action and social advocacy. Dental hygienists who are well educated and who contribute to advocating for greater accessibility to oral health care services will in turn contribute to reducing oral health disparities for the population.

North American societies are becoming increasingly diverse in their ethnocultural makeup. According to the Canadian Public Health Association, immigrants and refugees as well as Aboriginal people and people in such disadvantaged circumstances as the poor, elderly, and disabled are most vulnerable to disease, and experience the greatest degree of health disparities. Differences in cultural values, beliefs, and language are cited as barriers to accessing health care, and it is possible that health providers may contribute to these disparities by stereotyping, being prejudiced, and being clinically uncertain as to how to provide care to this population. Increasing cultural competence among health providers has been suggested as a possible strategy for reducing such disparities. These strategies include recruiting students and educators of ethnically diverse backgrounds to the health professions, and incorporating cultural education into the curricula in order to improve culturally sensitive communication, to foster respect for cultural differences, and to educate future health professionals in the process of culturally competent, client centred care. This paper discusses the need for increased cultural competency in dental hygiene with the intent of encouraging further research into this highly required area.

The elderly comprise the nation’s fastest growing population, and by 2015 seniors aged 65 years and over will outnumber children in Canada. By 2031 there will be 8.9 to 9.4 million seniors between the ages of 65 and 85 years.1 While people of all ages are at risk for family violence, the elderly are especially vulnerable. It is believed that this type of violence is not only grossly under reported but is as common as child abuse. Elder abuse can be defined as “mistreatment of older people by those in a position of trust, power or responsibility for their care.”2 A telephone survey of 2000 randomly selected Canadian seniors, stratified by geographic region, estimated the prevalence of elder abuse at 4 per cent.3 Estimates in other jurisdictions have ranged as high as 10 per cent.4 The causes of elder abuse include many of the same factors that contribute to family violence in general; they are numerous and complex. Older persons who are perceived or perceive themselves as helpless are often targets of abuse. There may also be a long term pattern of violence where the abuser becomes the abused. The physical and psychological consequences of all forms of maltreatment can be so damaging and irreversible that the older person may long for the release of death.5 Dental hygienists can play an important role in the recognition and reporting of elder abuse. It is common for clients to visit the same dental hygienist for a one-hour appointment every 3 to 9 months, and thus to develop rapport and professional relationship based on trust. One American study found that due to the increased rate of periodontal disease and need for continuing care in this population, the average elderly person makes two dental visits per year.6 In Canada, 46 per cent of seniors taking part in a 2003 survey reported regular dental visits. Following changes in health care legislation, increasing numbers of dental hygienists across Canada are now able to provide mobile dental hygiene services to senior clients in their homes and retirement living centres. Dental hygienists are favourably situated to recognize and report elder abuse and neglect, and to provide resources to victims. Two-thirds of the injuries sustained in abuse of older adults can be easily found during a routine oral examination with over half of these injuries occurring in the head and neck region.7 Dental hygienists should be alert to suspicious injuries of clients’ head areas along with bruises in different stages of healing. In a national survey of Canadian dental offices, the most commonly reported signs of physical abuse were bruises and welts, broken dental prostheses, fractures and avulsed teeth, and abrasions and lacerations. The types of neglect most often observed included poor personal hygiene and failure to provide adequate dental care.8 Dental hygienists have a professional responsibility to question how injuries and scars came about, and to be attentive to non verbal as well as verbal cues. In Canada, there are a number of laws related to abuse and neglect. According to the Canadian Network for the Prevention of Elder Abuse, such legislation includes family violence statutes, criminal law, and adult protection and guardianship laws. How effective are Canada’s laws? There are many attitudinal barriers within the justice system that can discourage victims’ access; however where adequate supports are in place, and through education and advocacy many of these barriers can be reduced.9 Dental hygienists are ethically and legally obligated to report suspected cases of elder abuse and to advocate for their clients. A report10 published in the Journal of Dental Hygiene assessed the likelihood of dental hygienists reporting abuse before and after a training program. Prior to training, only 40 per cent definitely knew that they would report abuse and only 5 per cent stated that they knew how to complete a report. After training, all stated that they would report the abuse and 96 per cent indicated that they knew how to complete a report.10 This study points out that many professionals are uncomfortable talking about these problems, and that they may not know how to document and act on their suspicions. In another study, 12 per cent of dental hygienists who suspected elder abuse reported taking no action to aid their clients; however three quarters of the dental hygienists surveyed stated an interest in professional development in this area.11 This strongly suggests that dental hygienists would benefit from more education on the signs, symptoms and reporting mechanisms of elder abuse. Dental hygienists have a responsibility to promote and support the rights and well being of their clients. You can find up to date facts on elder abuse and neglect in Canada on the website of the Canadian Network for the Prevention of Elder Abuse at http://www.cnpea.ca

The immune response during periodontal disease is a complex cascade of events that involves many components of the immune system. Although periodontal tissue destruction is initiated by bacteria, it is primarily caused by the host immune response. The most abundant white blood cell in the periodontal lesion is the neutrophil. High neutrophil levels have been shown to correlate with cases of severe active periodontal disease. This review discusses current understanding of the role of the oral innate immune system in periodontal health and disease, and how this information is being used to develop novel tools for detecting and diagnosing this common oral infection

Background: Psychiatric illness and its medical management carry significant risks for oral disease. Given the ongoing shift in treatment approach from the traditional institutionally based model to more community focused alternatives, dental hygienists can expect to see and treat patients with various forms of psychiatric disorders. Discussion: The purpose of this paper is to provide the dental hygienist with a background understanding of psychiatric disease and highlight the various oral health findings that so frequently manifest themselves in this specialized patient population. The type, severity, and stage of mental illness, a patient’s own mood, motivation and personal perception of oral disease and lifestyle, and side effects of medications all contribute to the oral manifestations of many of the more serious psychiatric diagnoses. Both the disease itself and its pharmacologic management exact a range of oral complications and side effects, with caries, periodontal disease, and xerostomia being encountered most frequently. Conclusion: Through an increasingly successful combination of pharmacotherapy, psychotherapy, and life adjustment skills counselling, patients are attempting to better understand and cope with their underlying psychiatric illness. In turn, this will promote a more positive and progressive interaction and re-integration within society as a whole. The dental hygienist can also contribute to this process of rehabilitation not only through a heightened sensitivity and understanding of a patient’s specific psychological vulnerability but also through the management of specific oral health needs and concerns that are often a component of psychiatric illness.

Purpose: This review explores the relationship between the progression of periodontal disease and the use of removable partial dentures. Method: Medline/Pubmed, Cochrane Library, and Google Scholar were searched for studies published after 2000 regarding periodontal health considerations with the use of removable partial dentures in clients using key words periodontal health and removable partial dentures. The search resulted in twenty-four published articles, of which twelve were relevant to the topic including eight studies and four reviews. Results: Research shows that removable partial dentures (RPD) can cause an increase in the accumulation of plaque bacteria that could lead to progression of periodontal disease, but if clients have effective self care strategies and regular periodontal maintenance this increase in plaque bacteria could be prevented. Defective RPDs and certain design features can cause progression of periodontal disease. RPDs are a good treatment alternative provided that the prosthesis is well constructed, and that the client attends regular periodontal maintenance visits. Conclusion: Current research indicates that well constructed RPDs, used with regular periodontal maintenance, are not likely to pose a risk to existing periodontal health. However, additional research in the form of longitudinal studies is needed to further investigate the effects of RPDs in the progression of periodontal disease.

According to various oral health outcome measures, steady improvements over the previous century have resulted in Canadians being among those with the greatest oral health status in the world. Paradoxically, the socio-economically disadvantaged have not realized the same substantial improvements in their oral health status as the more advantaged, with the former demonstrating poorer oral health. These disparities, evident in overall health as well, reflect complex issues and require sophisticated, multidimensional strategies to mitigate them. Part I of this paper, published in volume 42.6 (November–December 2008), provided a summary of the literature about the various oral health status measures used to assess these varying disparities between Canadian social groups. This part of the paper will provide a description of various exposure variables that contribute to the outcome disparities discussed in Part I, and will begin to explore the potential impact the dental hygiene profession can make in reducing the oral health disparities between less advantaged and more advantaged Canadians.

Xerostomia or dry mouth syndrome is a common but often overlooked condition, which can contribute to tooth decay, oral mucosal lesions, halitosis, and greatly affect an individual’s quality of life. While clinical trials on dry mouth palliation date back to the early 1980s, the ideal remedy, with good substantivity, lubricity, antimicrobial properties facilitating mucosal healing and enamel remineralization, is yet to be found. There are a number of over the counter (OTC) remedies designed to palliate dry mouth which vary greatly in active ingredients, delivery form, availability, price and effectiveness. Current xerostomia products can be divided into two broad categories, saliva substitutes and saliva stimulants, and can further be classified into four groups based on the main ingredient: biopolymers, salivary enzymes, acid based, and petroleum based. The purpose of this paper is to present a review of the literature in conjunction with the Health Canada Drug Database (DDB) in order to provide up to date, evidence based information on OTC xerostomia products in general, with emphasis on those available in Canada at the time of publication. Analysis of scientific publications is intended to provide insight into composition, delivery vehicle, benefits, side effects, and effectiveness of such preparations, enabling optimal delivery of care in edentulous and dentate patients with xerostomia.

Quebec Order of Dental Hygienists, L’Ordre des hygiénistes dentaires du Québec (OHDQ), undertook a program of activities, from 2004 to 2007, to motivate its members to integrate smoking cessation counselling into their daily practice. Specifically, OHDQ gave presentations and interactive training sessions, published articles in their professional journal, and made public their position on smoking during the “World No Tobacco Day”. The overall goal was to build capacity among dental hygienists to conduct cessation interventions by sensitizing them to their role in regard to counselling, by providing information about cessation counselling and pharmacotherapy, and by informing them about resources available in the community to help smokers quit. In spring 2005, a survey was conducted in a random sample of 500 dental hygienists to identify their counselling practices and beliefs, barriers that they perceive in providing counselling, as well as the kinds of help they would prefer in order to help them better intervene with smokers (training, documentation for smokers, practice aids). The data provided baseline information so that trends in counselling practices could be monitored over time, and adjustments be made to training interventions of dental hygienists. The response proportion was 70 per cent. The data suggested that the counselling practices of dental hygienists were not optimal—only 26 per cent assessed if smokers were ready to quit, and 25 per cent discussed strategies to quit with smokers preparing to quit. Although dental hygienists believe that they should intervene with smokers, they feel that they do not have the skills to intervene effectively. The challenge for OHDQ is to develop activities for dental hygienists that will increase their skill levels and their self perceived competence to provide effective cessation counselling.

Background: Peri-implant pathology consists of a chronic infection of the implant supportive tissues; its pathogenesis characterized by either the traditional pathway (from the soft tissues apically to the bone), or retrograde (from the bone to the soft tissues). In non surgical treatment, hyaluronic acid and chlorhexidine appear as eligible substances to apply in non surgical protocols, due to its antimicrobial and healing characteristics. This study aimed to compare the efficacy of a protocol for irrigating peri-implant pockets using a plastic needle with 0.8% HA or 0.2% CHX, through evaluation of clinical parameters included in the implant success criteria. The hypothesis tested was if the treatment success followed the same distribution in the HA and CHX groups. Methods: The study enrolled eighteen clients with one implant presenting probing pocket depth up to 6 mm. Bone loss and bleeding on probing were treated through mechanical debridement, and were randomly allocated to either a treatment with 0.8% hyaluronic acid (AH) or with 0.2% chlorhexidine (CHX) gels for irrigation of the peri-implant pocket. The success criteria determined that after the implementation of the protocol, the implants should have a modified bleeding index=0, probing pocket depths = 4 mm, improvement of the attachment level, no suppuration and no clinical mobility. Results: The percentage of success for the treatment in both groups was 55 per cent and 89 per cent for the HA and CHX groups respectively. Intragroup analysis when compared to baseline, revealed a statistically significant improvement in both the HA and CHX groups on the clinical indices performed in the final evaluation. No significant differences were found between the two groups in treatment success. Discussion: The results obtained in this study favour the adoption of non surgical protocols. The fact that no significant differences were found between both groups supports the research hypothesis in the use of HA in the treatment of pockets up to 5 mm and of CHX for the treatment of pockets up to 6 mm. Conclusion: It was possible to conclude within the limitations of this study, that the use of non surgical therapy is effective, making it possible either to treat peri-implant pathologies with a simple protocol, or to prepare the site for surgical therapy in case of an unsuccessful treatment.

Oral cancer is on the rise worldwide, with over 200,000 cases diagnosed yearly. The predisposing social and cultural habits related to this disease acquired in resource-poor countries in Southeast Asia remain prevalent among its users following migration to other and better resourced countries. As a result, countries that once rarely experienced high levels of oral cancer will likely see an increased incidence of this disease. Therefore, oral health professionals need to be aware of the cultural risk factors and the resulting oral health effects in order to respond effectively to the increasing incidence of oral cancer. The objective of this overview is to inform what is known about populations from resourcepoor countries in Asia in regards to oral cancer and its related cultural factors.

While overall, the oral health of Canadians has improved according to several outcome measures, on closer inspection a widening gap exists between those with the highest oral health status and those who are the least healthy orally. This is largely due to the socio-economically advantaged having substantial improvements in their oral health status while the less advantaged are not realizing similar gains. The resulting disparities are not unique to oral health, and are also evident in general health. The reasons for the polarization in oral health status are complex and require sophisticated, multidimensional strategies to mitigate them. This paper provides an overview summarizing the literature about various oral health status measures and will begin to illustrate the oral health disparities that exist in several sub population groups of Canadians. Both traditional clinical oral health measures, and the more subjective psychosocial measures are included in the review. The former measures include dental care utilization rates, caries experience, periodontal measures, tooth loss and oral lesions, while the latter measures include quality of life and oral satisfaction measures. While this review focuses on the various measures used to assess oral health, it will introduce such population groups as First Nations, new Canadians, seniors, socio-economically disadvantaged, remotely located and institutionalized that collectively demonstrate lower oral health status than less marginalized Canadians. The status quo in oral health care delivery has benefited many Canadians, but it has left a significant proportion without comprehensive care, and subsequent poorer oral health. Part II of this paper, to be published later, will describe the various exposure variables operating as contributing factors and causal forces for the outcome measures described here. This subsequent review will also provide an exploration into potential impact the dental hygiene profession could make in assuaging these disparities.

Data sharing, and secondary analysis of archived data, can contribute to the advancement of knowledge and to greater transparency in scientific inquiry. These processes also make maximum use of public funding for research by making available sets of data for further analysis and discovery. However, data sharing raises some interesting ethical questions around the re-use of research data from human subjects. In Canada, the Tri-Council Policy Statement (TCPS) identifies a number of ethical principles for research involving human subjects including respect for human dignity, respect for free and informed consent, respect for vulnerable persons, respect for privacy and confidentiality, respect for justice and inclusiveness, balancing harms and benefits, minimizing harm, and maximizing benefits. The main ethical principles that need to be addressed when preparing data for archiving are informed consent and protection of privacy and confidentiality, especially around storage, security, and access requirements. Researchers who are planning to share their data need to address preparation for data archiving in the initial design stage. Education and training programs that prepare researchers, including graduate and post-graduate programs, need to evolve such that the practice of data archiving becomes automatic to build the necessary capacity for a culture of data sharing. When data is to be shared, the only appropriate ethical perspective is to view the data as an extension of the individual who contributed it, and to accord it the same respect in secondary as in primary analysis.

The incidence and mortality of cancer are on the rise in Canada. Chemotherapy is a highly aggressive, systemic cancer treatment that is used solely, or in conjunction with other modalities such as surgery or radiation. Its purpose is to cure a cancer, provide symptomatic relief or palliative comfort, and improve quality of life. Consequently, clinically practising dental hygienists can reasonably expect that they will provide care, at some time, to clients who have had cancer or are undergoing treatment for the disease. As primary oral healthcare providers, dental hygienists are responsible for providing comprehensive, safe, and effective care for a variety of healthy and medically compromised people. Oral and medical side effects, as well as psychosocial issues affecting clients undergoing chemotherapy will have an impact on the assessment, diagnosis, planning, and implementation of dental hygiene care. Information provided by an intraoral assessment, review of the medical history, consultation with physicians, oncologists and dentists, and listening to the client, will enable dental hygienists recognize some of the oral complications of chemotherapy and provide helpful home care advice